Weight loss surgery has been seen as the solution to obesity issues for some people—a complex disease (involving excessive body fat) that is not easily controlled. Before you are recommended for weight loss surgery, you must have undergone other methods unsuccessfully. If all fail, then weight loss surgery becomes your only solution to have a healthy weight and lifestyle. However, these surgeries are costly and not affordable to every person. For instance, depending on your location and type of surgery, you may have to part with between $17,000 to $30,000 for bariatric surgery.
However, do not panic because Medicaid is here to help you get weight loss surgery if you match the qualification criteria. Medicaid has different surgery coverage in other states; therefore, you need to verify the coverage in your area. Additionally, it would be best if you worked with your physician to be approved for Medicaid coverage for your weight loss surgery. In this tutorial, we will answer your question, does Medicaid cover weight loss surgery criteria? Come with us!
Does Medicaid Cover Weight Loss Surgery?
To answer the question of whether Medicaid covers weight loss surgery, let us first know what it is. Weight loss surgery is typically done on obese people to help them lose weight. As mentioned above, the process is very costly and requires one to seek financial support from several programs; Medicaid is one of the programs where you get financial help.
There have been a lot of reported cases of obese people in the United States. This has increased the number of people seeking to know if Medicaid offers support for weight loss surgery. Fortunately, you can now get help to undergo weight loss surgery under the Medicaid program. However, there is a criterion that you must meet to qualify, as we are going to see in the section below.
What are Medicaid’s Criteria for Weight Loss Surgery Coverage?
Are you looking for weight loss surgery coverage from Medicaid? You are lucky because there are high chances of your weight loss surgery bills being settled under the Medicaid program. However, there are set requirements that you must meet for Medicaid to pay for your surgery. Below are some of the guidelines that one must meet;
- All male applicants must be above 15 and females above 13.
- You must have a BMI above 40 if you are under 21 years and 35 if you are above 21 years.
- You must present a letter from your doctor proving that you need to undergo weight loss surgery.
- You will need a pass in a psychological review to confirm that you will undertake the program after undergoing surgery.
- You must present proof that you unsuccessfully managed comorbidities using standard treatment. Some comorbidities include sleep apnea, high blood pressure, high cholesterol, and diabetes.
- You will need proof showing your participation in a weight loss program controlled by the clinic for six months. This should happen one year before you undergo the weight loss surgery.
- You must confirm that you are willing to change your routine and diet after undergoing weight loss surgery.
Those are the qualification measures that Medicaid has set to qualify weight-loss-surgery applicants. You should apply if you have already met all of them. However, only some qualify for the program, as many may give up during the approval process. What can make me not qualify for the Medicaid weight loss surgery program? Join us in the next section as we give reasons for disqualifying the program.
Reason for Disqualifying from A Medicaid Weight Loss Surgery Coverage?
Have you applied and failed to get coverage? Here are some reasons why you did not qualify for the Medicaid coverage
- You did not comply with previous medical treatments.
- You have some conditions like chronic pancreatitis, inflammatory bowel disease, and pregnancy.
- You have been proven to have psychological treatment, which mostly interferes with post-surgery.
- You have cancer.
- You have been using steroids for a while.
Which Weight Loss Surgeries Are Covered by Medicaid?
Medicaid covers several weight loss surgeries, but this section will discuss the most accepted by Medicaid. These include gastric bypass, lap-band, and gastric sleeve surgery. Medicaid believes that these three are very critical in human health. Let us get into each surgery’s details.
Gastric bypass is a surgical procedure primarily aimed at bypassing part of your intestines’ way of sending food directly to the lower intestines. The surgeon typically operates the gut and small intestines on how the absorption and digestion of food are done in your body. Additionally, the surgery focuses on reducing your stomach’s size, allowing you to eat small amounts of food.
Gastric bypass surgery enables the following;
- Ensures that there is no absorption of many calories and nutrients, which leads to weight loss.
- It restricts the amount of food held in your gut.
- It transforms the gastrointestinal hormones —responsible for suppressing your appetite by making you full for a long.
Lap-Band surgery is a procedure whereby a surgeon places an adjustable band of silicon around the top part of the stomach. The main aim of this surgical procedure is to ensure that there is a small space that can hold food. The band is placed in a way that creates a smaller gut section above the band, and the rest remains below the band.
Lap-Band surgery limits you from taking large amounts of food and beverages in one sitting. This procedure is typically done laparoscopically, making it minimally invasive compared to other surgeries. Fortunately, you can always adjust the band, and the procedure is reversible.
Gastric sleeve surgery
The gastric sleeve surgery procedure mainly aims to create a smaller stomach with a shape like a sleeve. According to experts, the surgery removes about 75% of the stomach, giving a small space for the food to sit. All the other food is usually directed downward through the intestines reducing the amount of food absorbed into the body.
The gastric sleeve procedure is considered more effective and is currently common in the United States. This is an irreversible procedure, so you must be certain before undergoing it.
The process of getting Medicaid coverage can be very frustrating; you might end up giving up if you are not prepared. However, once you get it, you are usually guaranteed full coverage if it is surgery for an individual. Be patient and follow the steps; you will get Medicaid coverage for the surgery you need.
What’s The Process of Weight Loss Surgery Approval by Medicaid?
Are you living in a state where Medicaid offers weight loss coverage? You can get weight loss surgery approval by following the step-by-step process as discussed.
1. Meet with your physicians
If you live in a state that covers bariatric surgery, you will need to meet your physician to obtain approval for your situation. Medicaid will require you to provide proof from your physician that your case requires surgery before they can give you coverage. It is typically vital for your physician to provide Medicaid with information regarding your situation. Finally, the physician can refer you to an approved surgeon for an assessment of your situation for Medicaid to see the urgency of your surgery.
2. Go through some tests to determine your medical health
In most cases, your physician will recommend you to an approved surgeon. So, when you meet the surgeon, they will take you through the basics of the surgery, where you will discuss your options. Additionally, they will take you through various tests to determine your health before you undergo surgery. Lastly, they will request your surgery pre-approval from the office of Medicaid. Kindly note that this step may consume a lot of time, so you must be patient.
3. Attend classes as requested by Medicaid and the surgeon
Your surgeon, in collaboration with Medicaid, may request you to start attending classes before you undergo surgery. During these sessions, you will discuss the surgery, nutrition, and exercise you will be doing after the surgery. Additionally, you will discuss how you can change your lifestyle immediately after the surgery for effective weight loss.
This step is key because it prepares you for what to expect after or close to the surgery process. Besides, you will be taught your role after getting weight loss surgery sponsored by Medicaid coverage.
4. Approval of the Medicaid coverage
After the application, there are chances to be approved or denied Medicaid coverage. Once approved for the surgery, Medicaid may require you to meet some provisions before you undergo surgery. This may mean you get extra tests and classes, among other things. Fortunately, in most cases, the surgeon will work with you to accomplish these requirements. The surgeon’s involvement in your procedure guarantees full approval of the surgery covered by Medicaid.
5. Confirmation of the surgery
After the approval by Medicaid, the surgeon will have to confirm when you are ready to undergo surgery. This may mean preparing some procedures like x-rays, blood work, and other medical preparations for the surgery process. If these are set, you will be ready to start the journey toward achieving your weight goal.
6. Be acquainted with the part of surgery covered
It is often hard to tell the part of the surgery if any Medicaid will cover in your area. To determine the surgery covered, kindly visit your local Medicaid office and confirm which type of surgery Medicaid covers. Ensure you confirm every requirement, for instance, the approved surgeon you have used if they are listed in their list of surgeons. Medicaid has friendly agents ready to give you all the information you need in this subject matter. Fortunately, if surgery is the only way to restore your weight health, Medicaid is always ready to cover the expenses. So, give it a shot and be patient as the process may be long; however, the assistance is worth waiting for.
Are There Any Cheaper Ways for Weight Loss Surgery if I Am Not Getting Medicaid Coverage
Have you applied for weight loss coverage by Medicaid, and the application got denied? Do not panic. There are several options that you can get cheap weight loss by applying through some organizations. Some of these organizations include;
- Humana insurance
- United Healthcare
- Health First
- Blue Shield
Those are some organizations where you can get cheap weight loss surgery coverage. Apart from the organizations, there are states where you can get cheap weight loss without insurance coverage. These include the following;
- Georgia, you will pay $11,200 for weight loss surgery
- Nebraska, you will pay $11,700 for weight loss surgery.
- Kentucky, you will pay $12,600 for bariatric surgery
- Arkansas, you will pay $15,300 to get bariatric surgery.
- Nevada, you will pay $16,500 to get weight loss surgery.
Those are some states where you will get cheap weight loss surgery. However, you can visit different charity organizations or raise money and use it to cater to your bariatric surgery. Finally, you can opt for a medical loan to undergo surgery and repay after the surgery.
How Long Does It Take Medicaid to Approve Weight Loss Surgery?
Medicaid takes you through a supervised program for six months before you get approval. During this period, there are other programs that you will undergo, including classes and tests to prepare you on what to expect before and after the surgery.
How Much of the Surgery is Covered by Medicaid?
In most cases, Medicaid will cover all your expenses to undergo weight loss surgery. However, if a part of your surgery is not covered, you may have to look for supplemental insurance to help. Besides, there are also charity organizations that help you cover your weight loss surgery bills. This enables you to finish up any remaining balance in your weight loss surgery.
Can Insurance Cover Weight Loss Surgery?
Yes. Different insurance companies currently cover different procedures, although most offer partial coverage. Most insurance companies cover gastric bands and sleeve surgery, with lap band surgery not covered by many insurances. This is after the procedure was considered experimental, leading to many insurance companies withdrawing the coverage.
Is Bariatric Surgery the Same as Weight Loss Surgery?
Bariatric surgery is also known as weight loss surgery, a surgical procedure that primarily aims to help obese people lose weight. This process is recommended by healthcare providers, especially when you have unsuccessfully tried all the other methods.