Medi-cal? - ThinnerTimes

taffy4185 · 04-09-2008, 03:17 PM

Hello, im new! my names tiffany >_<
ive just started the process to see if I am able to get a Lap band. I have my first group meeting on the 2nd of may. My question was, Does anyone know what are the requirements in order to qualify for medi-cal to pay for the lap-band, as in Like 6month diet, or psych exam???

just some info for you guys... im over 100 pounds over weight and my bmi is over 50, and i suffer from sleep apnea.

Thank you for any help you guys can give me!

JumboJulie · 04-09-2008, 05:14 PM

Hi, I might be able to help a little ...

I used Medicare/Medi-Cal to pay for my gastric bypass. The way it works is they don't pre-authorize like most insurances do. Your surgeon bills the insurance AFTER he/she operates on you. So what I needed was a list of my medical problems, meds, family history, blah, blah, blah ... but the most important was a list of diets I've been on (detailed list) plus a long letter from my primary care physician explaining why the surgery would benefit me. Your PCP has to include info like you have been morbidly obese for at least 5 years ... that diets have failed ... that your medical problems are severe enough to warrant the expence of the surgery ($25,000). I have had my doctor for the last 12 years and is very supportive of the surgery, so he wrote me a wonderful letter, I was very lucky. You will also need a psych eval. and that is because the state of California requires it. No exceptions. Unfortunately, Medicare nor Medi-Cal will pay for it, so you must pay cash out of your own pocket. I paid $150.00 for this. But that was the ONLY out of pocket expense I had, so I can't complain at all. You are NOT required to do the 6-month diet, or liqiod diet, or any other special diet before-hand. Your surgeon may require something like that, but your insurance does not.

Hope this helped.

calicowgirl · 04-09-2008, 05:54 PM

Do you have a plan THROUGH medi-cal or straight medi-cal? I have HealthNet through medi-cal and I basically have to do it just as the HealthNet website says- medi-cal isn't the ones giving me my guidelines.

I DO have to have the 6 month diet, psych eval, etc.

Call your social worker. She'll be able to tell you what you have to do. Your surgeon's office can help too.

taffy4185 · 04-09-2008, 11:42 PM

Quote:

Originally Posted by calicowgirl

Do you have a plan THROUGH medi-cal or straight medi-cal? I have HealthNet through medi-cal and I basically have to do it just as the HealthNet website says- medi-cal isn't the ones giving me my guidelines.

I DO have to have the 6 month diet, psych eval, etc.

Yes i have straight medi-cal.

JumboJulie · 04-10-2008, 05:33 PM

I have straight Medicare, and straight Medi-Cal as a supplimental insurance because I am on disability. I do not go through an outside HMO or PPO like Healthnet or Bluecross or anything like that. For me getting the surgery was very easy.

shadia · 05-02-2008, 10:21 PM

hi im just begining this process also i have straight medi-cal maybe you can tell me the steps youve taken and if youve been succesfull my bmi is 43 im 25 with hperthyroid emimic sleep apnea asma shortness of breath severeback pain and pre diebetic

shadia · 05-12-2008, 10:47 PM

im wondering if you were sucessful with your straight medi-cal please let me know

jva2009 · 06-11-2008, 11:13 AM

Hi I live in San Francisco and I am tring to get on Medi-cal. I am 5'2" and 300 pds. I got a clear go from General Hospital, but I now need to get that insurance. I took all the tests etc. Any advice? Please help!! Thank you!!