New girl with an insurance question

  • Hello all.

    I have been doing a lot of research into WLS, and I have come to realize that the bypass is the only way I am ever going to be a "normal" weight. I have been on many, many strict exercise programs, diets, fat burners, energy pills, etc. and all to no avail.

    I have a severely disabled 2 year-old son who requires constant care, leaving me unable to work. It has come to the point that I can barely do his physical therapy without being completely winded and in pain.

    Since I am unable to work, I am enrolled in Unison Health Plan, a Medicaid insurance program. In my benefits packet, it doesn't mention any weight loss coverage, but it doesn't say that it ISN'T covered either.

    I was wondering if anyone has any experience with this type of insurance, and whether or not it is covered/how big of a fight it will be to get the procedure. I have an appointment with my doctor to discuss this next week, but I want to be as prepared and knowledgable as possible when I see her.

    Thanks in advance for any info and advice,

    Jennifer
  • WOW. issues galore here. the only thing i could suggest is to ASK the insurer - i know that MEDICARE funds bypass surgery, but since MEDICAID is state-funded and state-run, with rules set on a state-by-state basis, it's impossible to tell you yes or no. MEdicare is federal - and it's one size fits all.

    but, be prepared to stand up for yourself - there will probably be quite a few hoops to jump through. keep us posted!!!!
  • Medicaid does cover it here but there is quite a process for pre-approval. I read of one person that tried to get them to cover it...they had to retain a lawyer and appeal...appeal...appeal.

    Fight for your life, it took me 3 years before medicare would cover mine...and it was WORTH IT EVERY MINUTE OF STRUGGLE!

    Good luck to you.

    Angela
  • To get a quick idea of whether of not your insurance covers weight loss surgery, this site works. obesitycoverage.com
    hope that helps
    Tasha