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Saturday, March 12, 2011 Kathi May, Community Member, asks

Q: Does Alabama Medicaid cover the cost of gastric bypass?

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Answers (2)
Phat in My 40's, Health Guide
3/21/11 9:21am

Hi Kathi,

 

Here is a listing (pdf) of what obesity-related services are covered by different state's medicaid departments.  It appears that bariatric surgery is covered under Alabama Medicaid (one surgery/patient) if supporting evidence is documented.  Here is the specific information:

 

Covered Procedures:
Gastric Bypass and Lap Band surgeries. Agency covers one surgery/patient.
Prior Authorization: Beneficiary must have a
1) BMI consistent with morbid obesity diagnosis;
2) Presence of obesity-related medical complications;
3) Planned adjunctive therapy before and after surgery;
4) Physician-patient risk benefit counseling;
5) Minimum 6 months physician-supervised weight loss efforts BMI consistent with morbid obesity diagnosis.8

 

If you go to the pdf, you will find links to related documents at the bottom of each page.  You may want to check those out.

 

 

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My Bariatric Life, Health Guide
3/23/11 9:46pm

Kathi, You'll also need to locate a surgeon who will accept Medicaid in Alabama for the gastric bypass. Have you found such a surgeon?

 

Be aware that Medicaid will likely require you to follow a 6-mos physician-supervised diet and also may require a psych evaluation. This is no different from other insurers -- some have these same requirements (while others do not).

 

I was fortunate that my insurance company paid for my surgery without the 6-mos waiting period. I say lucky because when I made up my mind ot get the surgery, I wanted to have it then, when I was mentally prepared. I actually backed out of my first surgery date because I was scared. Well, I went back a few months later and had the surgery. It was defiantely the right decision for me. My overall health and well being is greatly improved and I am sure that I have added years to my life span.

 

Good luck with everything.

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By Kathi May, Community Member— Last Modified: 03/23/11, First Published: 03/12/11