Thursday, April 18, 2024

Does Ahcccs Cover Weight Loss Surgery

Covered Weight Loss Procedures

Medicaid covers weight loss surgery | Crystals Life


  • Gastric sleeve, gastric bypass, duodenal switch, & Lap-Band are covered under most plans that include bariatric surgery
  • Other procedures are usually not covered by insurance but often have discounts, tax savings, & financing available

Most health plans that provide bariatric surgery insurance will pay for the following procedures :

  • If denied, you can choose toappeal the denial.
  • Your surgeons office will be very experienced in managing the above process and may have all of the required personnel on staff .

    to get started. Most offices will check your insurance for free to confirm coverage criteria.

    Is There A Nutrition Recommendation

    Our bodies need building blocks to heal. I recommend eating a healthy, balanced diet that includes 100g of protein daily and a multivitamin for 2 weeks before and 4 weeks after your surgery to optimize your healing. We have a sample diet for you in the office. If you would like a copy, just ask us when you are here.

    How Am I Going To Afford Weight Loss Surgery

    If your health is suffering and you need bariatric surgery, there is a chance that your insurance company will cover some types of bariatric surgery. Since the inception of The Affordable Care Act, almost one-half of the U.S. states are required to cover weight loss surgery. The state of Georgia is not included in this list but falls under a 1999 Federal law that mandates coverage for morbid obesity.

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    Other Considerations For Medicaid

    One of the requirements for Medicaid to pay for your surgery coverage is that you need to have your weight loss surgery done through a Center for Excellence. Bariatric Center for Excellence accreditation is designed to indicate which bariatric surgery centers have achieved a level of excellence when it comes to administering bariatric surgery. Medicaid requires that you visit one of these specific centers to guarantee that you get the best possible treatment.

    Related: How to Appeal Insurance Denial for Weight Loss Surgery

    If you have questions about your Medicaid coverage and whether or not your coverage will pay for weight loss surgery, the best thing to do is to contact the people at Medicaid directly to discuss your coverage. There are many types of surgery that you can undergo weight loss, but Medicaid only covers the most common ones.

    If youre looking to have a different type of weight loss surgery aside from gastric bypass, lap gastric banding, or gastric sleeve surgery, then you will need to look for a different type of insurance coverage or you will need to pay out-of-pocket for the procedure.

    *Medicaid will not pay for weight loss surgery in Mexico


    Am I A Candidate For This Surgery

    AHCCCS (Medicaid) in Arizona?

    To qualify for surgery, you should be in good physical health and at least 18 years of age. I am happy to discuss surgery with younger patients but will not perform the operation until they are legally able to sign their own surgical consent form. We follow WPATH guidelines for more about that, click here. If surgery is to be done through insurance, typically it is required that you have lived consistently as your identified gender for at least 1 year and a letter of endorsement from your mental health professional is necessary. Informed consent is always required.

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    What Is Considered Low Income In Az

    Low income generally equates to under $50,000 for a family of four for a host of programs like Temporary Assistance for Needy Families, which is cash assistance to needy families the Arizona Health Care Cost Containment System, the states Medicaid program KidsCare, public health insurance for children child care May 19, 2017.

    Does Insurance Cover Weight Loss Surgery

    Many insurance plans do cover bariatric surgery, but there are variations in that coverage. Insurance coverage also may be affected by a facility or programs accreditation by a recognized institution. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program is just such an institution. According to its website, MBSAQIP accredits inpatient and outpatient weight loss surgery centers in the U.S. and Canada that have undergone an independent, voluntary, and rigorous peer evaluation in accordance with nationally recognized bariatric surgical standards. This accreditation not only promotes uniform standard benchmarks, but also supports continuous quality improvement. Norton Weight Management has recently received this accreditation.

    Once you decide to undergo a bariatric procedure, you have time to do research on insurance coverage, because youll be preparing your body for surgery, said Meredith C. Sweeney, M.D., a general, bariatric and laparoscopic surgeon with Norton Surgical Specialists. Dr. Sweeney sees weight loss surgery patients at Norton Weight Management Services.

    If your insurance covers weight loss surgery, you can begin looking for a facility and surgeon. Most programs offer free seminars for weight loss procedure candidates. If your health insurance policy doesnt cover weight loss surgery, you can look into financing the procedure.

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    What About Breast Cancer

    Most top surgeries, in order to avoid a scooped out chest appearance, will need to leave some breast tissue behind. In this way, the operation should be thought of more as a breast reduction than a true mastectomy. There will still be a risk for breast cancer, although diminished somewhat following the operation. Weekly breast self-examination should still be performed, and you should inform your primary doctor that you are still at risk of breast cancer to keep it on their radar. If you have a strong family history of breast cancer, please let me know. You might require genetic testing to determine your risk and help us to choose the right operation for you.

    Requirements To Qualify For Surgery Include:

    Weight Loss with Bariatric Surgery | Sleeve Gastrectomy & Gastric Bypass | theSITREP
  • Must have a doctors diagnosis of morbid obesity which includes a Body Mass Index of 40+ or 35+ and have a weight-related illness such as:
  • a cardiopulmonary condition, or
  • other serious medical condition that is life-threatening and weight induced.
  • Patients must also have gone through a structured diet program within 2 years preceding the request for the surgery. Qualifying programs would include or be similar to one structured diet program such as Jenny Craig or Weight Watchers for 6 consecutive months or two 3-month such programs that are completed and non-concurrent.
  • Patients must also undergo a psychological exam which is completed to determine if the patient understands and is committed to actively implementing and following the lifestyle changes necessary to achieve weight loss and maintain it after this type of surgery.
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    Covered Behavioral Health Services Include:

    Behavioral Health Day Programs including supervised day programs, therapeutic day programs, medical day programs Crisis Services including mobile team services, telephone crisis response, and urgent careInpatient Services including hospital, sub-acute, and residential treatment Rehabilitation Services including living skills, cognitive rehabilitation, supported employment, and education support Health Promotion â Prevention, Education and Medication Training â education and standardized training for the purpose of increasing an individualâs behavioral knowledge of a health related topic such as medication management, the nature of an illness, relapse and symptom management, stress management, parenting skills and health lifestyles Residential Behavioral Health Services include a range of up to 24hr/day services in a structured living environment for individuals needing support.Support Services including case management, personal assistance, Family & Peer Support, therapeutic foster care, respite, housing support, interpreter services, transportation, assistance accessing community resources and locating and applying for benefits, child care connections andTreatment Services – counseling, consultation, assessment and specialized testing, and substance abuse treatment.

    What Insurance Companies Cover Weight Loss Surgery

    This is a tough question to answer for a few reasons including:

  • Within insurance companies, there are several different plans available. One plan may cover bariatric surgery and others may not. Make sure you pay attention to all the details when choosing a plan
  • Plan and coverage details can change from year to year and even if you continue with the same plan, your premium may go up or they may change certain aspects of the coverage.
  • Patients face many challenges when attempting to navigate their way through all the confusing insurance requirements, qualifications, documentation, etc. We found this handy tool for checking insurance coverage online from bariatric-surgery-source. Use this tool as a guideline and always check with your insurance company about the details of your specific plan.

    If you are planning to have bariatric surgery and your insurance carrier does not currently offer this coverage, if possible, make a plan to switch companies during the open enrollment period. In the interim, begin working on the prerequisites required by your chosen insurance plan and gathering the required documentation.

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    Answer: Massive Weight Loss

    Insurance may pay for panneculectomy, after extensive documentation. They will not pay for abdominoplasty. Abdominoplasty is cosmetic and you have to pay for it.Panneculectomy is removal of the apron of skin regardless of the cosmetic results and the repair of the muscles and repositioning of the belly button.

    Weight Loss Procedures Without Surgery

    AHCCCS (Medicaid) in Arizona?

    Alternatives to weight loss surgery may include dietary and activity modifications and possible weight-loss drugs. Less food and liquids must be consumed than expended. To reduce your weight, you must:

    • become more active physically
    • create attainable lifestyle adjustments to help you keep off the weight.
    • consume the appropriate number of healthful foods.

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    What Age Does Ahcccs Cover

    AHCCCS offers health insurance for adult relatives who are living with and caring for a child under 19 years old and who meet income and eligibility requirements. For those who qualify, there are no monthly premiums.

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    Answer: Does Ahcccs Cover Breast Reduction If It’s Necessary For

    Hello! Thank you for your question. Candidates for #BreastReduction surgeryare women who wish to have smaller #breasts to achieve a more proportionalappearance or to alleviate physical discomfort. Breast reduction can correctsymptoms from excessively #largeheavybreasts that may cause the inability to docertain exercises, or create back, shoulder and neck pain, poor posture,bra-strap shoulder indentations and chafing or rashes under the breasts. Womenexperiencing these discomforts may benefit from Breast Reduction, also called #ReductionMammoplasty.Furthermore, large breasts may interfere with normal daily activities orexercise and will be more comfortable when reduced. Women who feel that theirexcessive breast size decreases a sense of attractiveness and self-confidence,or results in unwanted attention are also candidates. I recommend that you schedule multiple consultations with #Board #Certified #Plastic #Surgeons. Ask them to write letters of necessity to your insurance company for prior approval. I will attach a website which will give you all of the Board Certitied Plastic Surgeons in your area. Best wishes to you!

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    Medicaid Weight Loss Surgery

    Medicaid typically covers weight loss surgery and related procedures. However, in addition to the three main precertification rules, you must factor in a fourth consideration is the recommended method experimental.

  • Least costly: diet and exercise programs did not shed the excess pounds, and the type of bariatric surgery is not more expensive than alternate treatments
  • Medically necessary: Body Mass Index of 35 or greater combined with comorbidity: diabetes, high blood pressure, sleep apnea, high cholesterol
  • Regional rules: twenty-three states have insurance mandates for weight loss procedures that might apply to public plans
  • Not experimental: the Centers for Medicare & Medicaid Services deems specific procedure as unproven and will not honor claims
  • Given the complex criteria, the patients ability to gather the appropriate documentation determines how long Medicaid takes to approve the weight loss surgery. It could take weeks, months, or years depending on how well you and your doctor present the case.

    Which Elective Surgeries Does State Medicaid Cover

    7 Things You Should Know Before Getting Gastric Sleeve Surgery

    Medicaid typically covers life-sustaining surgeries such as open-heart procedures and operations to remove malignant cancers.

    But what about elective procedures that you schedule in advance to address other less threatening conditions? The answer is a resounding it depends because many operations fall into a gray area.

    Contact the company administering your plan and request precertification. The response will vary based on three questions, which this article addresses for commonly performed surgeries.

  • Is it medically necessary?
  • Is it the least costly alternative?
  • Does your state institute special rules?
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    What About Smoking Or Using Nicotine

    Patients currently using nicotine are not candidates for surgery. Blood testing for nicotine is frequently performed if there is any doubt. Using nicotine in any form is extremely detrimental to wound healing and can seriously impact your surgical result in a very negative fashion. You must be off nicotine for at least 6 weeks prior to the surgery and promise to remain off it for at least 6 weeks after to qualify.

    What About Dog Ears

    I hate dog ears just as much as you. I do my best to avoid them. I also hate scars, and so I might leave a little dog ear at the end of the incision to shrink some before I finally remove it. This will help minimize your final scar length. Sometimes preventing large dog ears will involve extra cost to include liposuction or to extend the incision off the breast and into the armpits. Sometimes it is simply not possible to completely remove a dog ear at the time of the first operation. Typically I let you heal and then finish the dog ear removal in the office

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    Medicaid For Weight Loss Surgery

    When it comes to using Medicaid for weight loss surgery, things get a little tricky. Why do you want to undergo weight loss surgery? Obvious reasons aside, your insurance company is going to want to see that you have done everything possible to take care of your weight, before undergoing weight loss surgery. You need to build a case for your insurance company that shows them you have a life-threatening disease that needs to be addressed to continue living a full and happy life. Start gathering your medical history. Have you tried other weight loss methods with no success? Your insurance will want a list of tried and failed methods. Read our Writing a Medical Referral Letter Blog.

    Many insurance companies will require that you have proof that you have been clinically obese for at least 5 years before you can undergo surgery. Most insurance companies will also except a letter of medical necessity from a bariatric surgeon, such as Western Bariatric Institute. Visit our Steps to Surgery to see how we prepare our patients for surgery and what you will need to do to get started with our bariatric surgery program.

    What Are The Risks Of Surgery

    Complications are pretty rare when the perioperative regimen is followed and the patient is healthy and close to ideal body weight. The most common complications are partial nipple loss and post-operative hematoma. Other potential complications include, but are not limited to, asymmetry, pain, contour deformity , scarring, nipple malposition, complete nipple loss and loss of nipple sensation. Remember, this is going to be a huge change to your body and your self-image. In many patients, the reaction is instantly positive. Still, some people have a hard time adjusting to the new shape and size of their post-surgical chest.

    Read Also: How Safe Is Gastric Sleeve Surgery

    How Will I Look After Surgery

    The obvious answer is, as good as I can make you look. I recognize that gender appearance exists along a spectrum from pure feminine to pure masculine. The better you can visualize your ideal chest and communicate it to me , the better chance I will be able to give you what you want. I have a great deal of control over final chest contour and post-operative nipple size and position, so think about how you would like your chest to be. Please look at post-operative pictures on the internet. The scars are permanent although they fade with time. Not all healing goes as planned. Sometimes there can be wound healing complications, asymmetries, contour deformities and/or partial or complete nipple loss that complicate the result. Many of these complications can be fixed, but they require additional surgery.

    Weight Loss Surgery Requirements

    You must fulfill the following conditions to be a candidate for weight-loss surgery:

    • with a BMI of 35 or above along with major obesity-related health issues
    • a BMI of 30 or higher and challenging-to-manage type 2 diabetes
    • less than 450 pounds in weight
    • BMI of 40 or higher, comorbidities present or absence

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    Weight Loss Surgery And Insurance Coverage

    According to The American Society for Metabolic & Bariatric Surgery , the average cost for bariatric surgery runs anywhere between $17.000 and $26,000 but the exact cost will be dependent on the type of surgery you have, your overall health, and current BMI, and if you encounter any complications, etc.

    There is much evidence to support that the cost of surgery is much less than treating the associated obesity-related conditions long-term. Most insurance companies will cover gastric sleeve surgery but not the less expensive non-surgical options such as a gastric balloon or endoscopic sleeve gastroplasty.

    Endoscopic sleeve gastroplasty has a proven track record of delivering results comparable to gastric sleeve surgery. It does not require surgery, it is less expensive, has fewer complications, and offers a faster recovery. This FDA-approved weight loss procedure is gaining popularity and has proven to result in significant weight loss.

    Even with the supporting evidence and FDA approval, insurance companies do not yet cover non-surgical EGS and currently only cover expensive surgery. Insurance companies in general are slow to cover new procedures, but most bariatric surgeons feel that endoscopic sleeve gastroplasty will be covered by insurance companies in the future because it would benefit all parties.

    All You Need to Know About Endoscopic Sleeve Gastroplasty – Accordion Procedure – Endosleeve

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