How Long Does It Take Medicaid To Approve Weight Loss Surgery?

Due to the increasing cases of obesity, a lot of people are opting for weight loss surgeries as an alternative for losing weight.

How Long Does It Take Medicaid To Approve Weight Loss Surgery?

So, if you want to go for a weight loss surgery and are wondering if your health care insurance will cover it or not? Then you are at the right place. Read on this article to understand how Medicaid can help you and how to get approved for a weight loss surgery.

Why weight loss surgery is required?

For people who are overweight and have a BMI(body mass index) of 35 or more even after walking and working out, losing weight can get challenging for them. So, in that case, doctors recommend weight loss surgery to avoid future medical issues like cardiovascular illnesses, Type-2 diabetes, high blood pressure, sleep apnea, etc.

Medicaid

Medicaid is government-funded health insurance that provides health coverage to over 72.5 million Americans including children, pregnant women, seniors, and individuals with disabilities. 

The mission of Medicaid is to promote a healthy community and health care economy, through; improving health care outcomes, patient experience, lower cost of care, and improve provider experience. 

Now that you know about Medicaid let us know more about how Medicaid can help you cover the cost of your surgery. 

Medicaid can help if you:

• Don’t make much money or you are on a limited budget
• Are already enrolled in Medicaid but can’t afford the payments
• Can’t work because of a disability
• Are pregnant and don’t have much money or make money

Weight loss surgeries covered by Medicaid:

1. Surgery for gastric sleeve
2. Surgery for gastric bypass
3. Gastric lap bands

What are the requirements of Medicaid to qualify for the surgery?

Medicaid and its procedures are entirely different from other insurance plans. If you are considering a weight loss surgery and want Medicaid to pay for it, you may have to jump through a few hoops. Let’s find out.

1.  In order to qualify for the surgery, you need to get a letter from your physician stating that you have been unsuccessful in losing weight even after improving your diet and exercise so a weight loss surgery is necessary to avoid future health problems.
2. BMI(body mass index) should be over 35 with at least one of the following comorbidities:
3. Type 2 diabetes
4. Obstructive sleep apnea
5. High blood pressure
6. Pseudotumor 
7. The age limit is over the age of 13 for a female and 15 for a male.
8. If you are under the age of 21, you must have a BMI over 40 with at least one comorbidity
9. Need to pass a physiological exam that is you have to complete and show a document which states, you have participated in a weight loss program under medical supervision for 6 months and it was 12 months before surgery
10. You should understand that it is necessary to bring changes in your lifestyle and have to follow a healthy diet plan after surgery.
11. There should be available services both nutritionally and psychologically after the surgery from your physician’s office.

You won’t qualify for Medicaid weight loss surgery coverage if:

• Long term steroid use
• You have Malignant cancer
• Inflammatory bowel disease, chronic pancreatitis, pregnancy, or non-compliance with medical treatment
• Psychological treatments that may interfere with diet and lifestyle

If you have any of these health-related issues you may not qualify because these can be a hurdle to your surgery.

The side effects of weight loss surgery

Weight loss surgery is a safe and alternative process to lose weight but there are certain risk factors involved in it, such as:

• Infections
• Blood clotting in lungs
• Internal bleeding

How long does it take Medicaid to approve weight loss surgery?

In most cases, it takes time for approval because it is a government program so the number of applicants is more in Medicaid compared to the private health insurance scheme. The waiting time for approval is for 5 months or less but before that Medicaid will review your records and input from your doctor before making a decision. 

How much does weight loss surgery cost?

The average weight loss surgery costs $17000 to $26000. The exact cost differs by surgery, circumstances, and potential. 

Hope this article was informative. Thank you