Michigan medicaid

[tinadago]

Hi there. I was sleeved last week and so far so good. My sister, who is quite a bit heavier than I am, whose BMI is well over 40, possibly 50 (not sure), wants to have the surgery done. She is on medicaid and doesn't think it's covered. She said something to her dr, who basically blew her off. I told her to check with a bariatric dr, and talk to them. They would know best what is covered under medicaid, and the best way to get it covered.....anyone have any experience with this? She needs this surgery more than I did, but I was self pay, and she doesn't have the $$ to pay for it.
Would love any advice....this forum has been my lifeline since I made this decision for myself.
Thank you

[MELR]

Hi Tina. I'm glad you are doing well. I am doing well too. When I see your posts, I always think of you as "Oh there's the girl who had her surgery on the same day as me."

Anyway, I found a link to Michigan's medicaid programsMichigan | Medicaid.gov It is my understanding that it is covered, you just have to find a surgeon who will take it (which is sometimes a problem, but I'm sure they're out there). I did read somehwere that bariatric surgeries were going to be harder to get because of the Affordable Care Act, so if I were her, I'd look for a surgeon now.

Hope this helps.

[MELR]

Medicaid's Criteria for Weight Loss Surgery | Obesity Coverage

[tinadago]

Thank you....and I'm glad you're doing well too! I think the same thing when I see your posts, lol. Do you have any pain at all anymore? I still have some discomfort on my upper left side, where I think our baby sleeve is located. It's not constant though. Also seem to have gas pains that come and go through out the day. I try walking them out. Any of this happening with you?
Thanks for the link for my sister

[MELR]

Yes, I'm still having some in my left side too. My surgeon did this deep muscle stitch which caused a huge sunken dent, but I think it is popped because the dent is gone. I'm losing well but I'm not getting my liquids and protein in. I don't even think I'm getting 40grams of protein and maybe 20 ounces of water. I've got to get that up and I feel like I'm "drinking" constantly. The nausea is gone and only happens if I drink cold water. I have a horrible chest cold but, other than that, I am doing exceedingly well. I'm surprised. I think i'm going to make it! LOL

[tinadago]

I have issues with my fluids & protein too. I've been trying to make myself have 2 of the premier protein shakes. They are 30g each.....but fluids I don't think I get 20 oz either. I've been doing about qtr cup of cottage cheese and qtr cup yogurt with fresh blended fruit....so that adds a little to my protein count. My dr said to advance slowly. I might venture into the poached egg tomorrow. I'm nervous lol. Something I did like was rice pudding but I didn't think I should have another because it has rice in it.

[Kletha]

My surgeon accepts it - with Medicaid they said you had to do 12 months of visits with a doctor to document the effort of weight loss before you could be scheduled for surgery. If her doctor scoffs at her, I would switch doctors to one who is more supportive.

[tinadago]

Wow, 12 months? I thought maybe 6 months.

[Carissa Ellis]

Hello,
I have been working in patient accounting for 6 years and know quite a bit about insurance. If your sister has straight medicaid she may not be covered. However if she has a medicaid hmo plan, it is possible but will take a lot of work on her end. 1st things first, with medicaid plans you cannot simply "go see a surgeon" EVEN IF THEY TAKE YOUR PLAN. They will not get paid if she doesn't already have a referral from her primary doctor. If her doctor blew her off and is not supportive, she needs to find a new doctor. Without written referral from here pcp, no surgeon will even look at her. Then she needs to find a surgeon that will take medicaid. It will not be easy and she may have to call 150 dr's. But eventually some one has to take it. She may have to look outside of her immediate area. Then she will have to see that surgeon each month for 12 months. 6 months is usually standard if you have a PPO insurance plan (no referrals needed and they pay the dr's A LOT more). Also, any evaluations that her surgeon requires (gastro, psych, cardiology, pulmonary) she has to find participating doctors, then get referrals for each of them from her primary care physician. If she is determined, it can definitely be done. And I'm sure you know much better she will feel if she is able to accomplish this. I wish you both the best. Remind her to be PERSISTENT. It is a long and frustrating process even with a good insurance plan. But it will definitely be worth it in the end.