Expert: Sara Scherer - 7/23/2006

Question
How can I get Mississippi Medicaid to pay for Gastric Bypass? If not help me find and Insurance that aperson on SSI can afford. Thank You for your help.

Answer
Mississippi Medicaid may not consider this a medically necessary procedure.  Gastric Bypass is dangerous to say the least.  And the older you are the better chance you have of dying from it.  Most people who are eligible for this procedure have the following illnesses: asthma, diabetes, high blood pressure, high cholesterol, at least 100lbs overweight and other associated illnesses.  If you do have at least 3 of the 4 listed above and have not tried exercise and diet to lose weight and have failed, chances are Medicaid is not going to cover this.  You also have to go through a psychological evaluation.  This is several hundred dollars.  This is to determine if you really are ready for the life change that this procedure is going to cause.  You lose weight but you also have to change your diet and you have to start to exercise.  

You are also not going to get an insurance company to cover it on an individual policy.  This procedure is about $40,000 plus after a year or so you have to pay for the tummy tuck and the arm tuck and everything else cosmetic that needs to be done.  The tummy alone is about $10,000.  So before you even consider having bypass you have to have the cash to take care of all of the loose skin you have after the surgery.

You can ask your doctor to make up an appeal for surgery for you.  But I would suggest that you seriously think about what you are doing before you determine this is for you.  If something goes wrong you could be in the hospital for weeks if not months.  The horror stories are enough to put me off having the surgery.  People with holes in their stomachs that don't heal.  People who have other illnesses.  People who can't eat at all because everything they eat makes them sick.  

Talk to your doctor before you make the appeal.  If you don't have a top notch surgeon, you could end up sick for life.

Sara