Medicaid in North Carolina may cover weight loss surgery for people who meet specific criteria. This includes having a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with obesity-related health conditions such as heart disease, diabetes, or sleep apnea. To be eligible, individuals must also have tried and failed to lose weight through other methods, such as diet and exercise, and must be willing to participate in a medically supervised weight loss program before and after surgery. Additionally, Medicaid may cover revision surgery for people who have experienced complications from a previous weight loss surgery.
North Carolina Medicaid Eligibility for Weight Loss Surgery
Medicaid provides health insurance coverage to low-income individuals, families, and people with disabilities. In North Carolina, Medicaid covers weight loss surgery for eligible individuals who meet specific criteria.
Eligibility Criteria
- Must be a North Carolina resident.
- Must be a United States citizen or have legal status.
- Must be 18 years of age or older.
- Must have a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with at least one obesity-related health condition, such as heart disease, type 2 diabetes, or sleep apnea.
- Must have tried and failed to lose weight through traditional methods, such as diet and exercise.
- Must be medically eligible for weight loss surgery, as determined by a doctor.
Benefits Covered
Medicaid covers the following benefits related to weight loss surgery:
- Pre-operative evaluations and tests.
- The cost of the surgery itself.
- Post-operative care, including follow-up appointments and nutritional counseling.
How to Apply
To apply for Medicaid coverage for weight loss surgery, you can:
- Submit an application online or in person at your local Medicaid office.
- Call the Medicaid customer service number at 1-888-245-0168.
- Apply for Medicaid through the Health Insurance Marketplace.
| Factor | Criteria |
|---|---|
| Age | 18 years of age or older |
| Residency | North Carolina resident |
| Citizenship/Legal Status | United States citizen or legal status |
| Body Mass Index (BMI) | BMI of 40 or higher, or BMI of 35 or higher with at least one obesity-related health condition |
| Weight Loss Attempts | Must have tried and failed to lose weight through traditional methods |
| Medical Eligibility | Must be medically eligible for weight loss surgery, as determined by a doctor |
Weight Loss Surgery Options Covered by Medicaid in North Carolina
Medicaid in North Carolina covers various weight loss surgery procedures to help individuals with severe obesity achieve long-term weight loss and improve their overall health. These procedures are covered under certain criteria to ensure they are medically necessary and appropriate for the individual’s health condition.
Covered Procedures
- Roux-en-Y Gastric Bypass (RYGB): This is a common weight loss surgery where a small stomach pouch is created, connected directly to the small intestine, bypassing the majority of the stomach.
- Sleeve Gastrectomy: This procedure involves removing a large portion of the stomach, leaving a narrow sleeve-shaped stomach that restricts food intake.
- Adjustable Gastric Banding (AGB): This procedure involves placing an adjustable band around the upper part of the stomach, which can be tightened or loosened to restrict food intake.
- Biliopancreatic Diversion with Duodenal Switch (BPD/DS): This procedure involves dividing the stomach and connecting the upper stomach pouch directly to the small intestine, bypassing the majority of the stomach and duodenum.
It’s important to note that coverage for weight loss surgery through Medicaid may vary depending on the individual’s specific circumstances, medical history, and the state’s Medicaid program guidelines. Individuals interested in weight loss surgery should consult with their healthcare provider and the Medicaid agency in North Carolina to determine their eligibility and coverage options.
Table of Weight Loss Surgery Options Covered by Medicaid in North Carolina
| Procedure | Description | Benefits | Risks |
|---|---|---|---|
| Roux-en-Y Gastric Bypass (RYGB) | Small stomach pouch created, connected to small intestine. | Significant weight loss, improved diabetes and hypertension control. | Leakage, infection, blood clots. |
| Sleeve Gastrectomy | Large portion of stomach removed, leaving narrow sleeve-shaped stomach. | Moderate weight loss, improved diabetes and hypertension control. | Bleeding, infection, stomach ulcers. |
| Adjustable Gastric Banding (AGB) | Adjustable band placed around upper stomach, restricting food intake. | Gradual weight loss, less restrictive than other procedures. | Band slippage, infection, esophageal dilation. |
| Biliopancreatic Diversion with Duodenal Switch (BPD/DS) | Stomach divided, upper stomach pouch connected to small intestine. | Significant weight loss, improved diabetes and hypertension control. | Malabsorption, nutrient deficiencies, diarrhea. |
Please note that this information is intended for general knowledge purposes only and should not be considered as medical advice. Individuals considering weight loss surgery should consult with their healthcare provider and the Medicaid agency in North Carolina for personalized guidance and to determine their eligibility and coverage options.
Process for Obtaining Medicaid Coverage for Weight Loss Surgery in North Carolina
Medicaid is a government-sponsored health insurance program that provides coverage for low-income individuals and families. In North Carolina, Medicaid covers weight loss surgery for eligible individuals who meet specific criteria.
Eligibility Criteria for Weight Loss Surgery Coverage
- Be at least 18 years old
- Have a body mass index (BMI) of 35 or higher
- Have at least one obesity-related health condition, such as diabetes, heart disease, or sleep apnea
- Have tried other methods to lose weight, such as diet and exercise, without success
- Be willing to participate in a supervised weight loss program before and after surgery
Process for Obtaining Coverage
- Talk to your doctor about whether weight loss surgery is right for you.
- If your doctor recommends surgery, they will refer you to a bariatric surgeon.
- The surgeon will evaluate you to see if you meet Medicaid’s eligibility criteria for weight loss surgery.
- If you meet the criteria, the surgeon will submit a prior authorization request to Medicaid.
- Medicaid will review the request and make a decision within 30 days.
- If Medicaid approves the request, you will be able to schedule your surgery.
Tips for Getting Medicaid Coverage for Weight Loss Surgery
- Make sure you have a clear diagnosis of an obesity-related health condition.
- Keep a record of your attempts to lose weight through diet and exercise.
- Be prepared to answer questions about your medical history and current health status.
- Be patient. The process of getting Medicaid coverage for weight loss surgery can take several months.
Medicaid Coverage for Weight Loss Surgery in North Carolina: A Summary
| Eligibility Criteria | Process for Obtaining Coverage |
|---|---|
| Be at least 18 years old | Talk to your doctor |
| Have a BMI of 35 or higher | Get a referral to a bariatric surgeon |
| Have at least one obesity-related health condition | The surgeon will evaluate you |
| Have tried other methods to lose weight without success | The surgeon will submit a prior authorization request to Medicaid |
| Be willing to participate in a supervised weight loss program before and after surgery | Medicaid will review the request and make a decision within 30 days. |
If you are approved for Medicaid coverage for weight loss surgery, you will be able to access a variety of benefits, including:
- Pre-operative and post-operative care
- Surgery
- Hospitalization
- Follow-up care
Resources and Support Services for Medicaid Recipients Undergoing Weight Loss Surgery in North Carolina
Medicaid recipients in North Carolina have access to a variety of resources and support services to help them through their weight loss journey. These resources include:
- Pre-operative and post-operative support groups
- Nutritional counseling
- Exercise programs
- Behavioral therapy
- Medication management
- Long-term follow-up care
In addition to these resources, many Medicaid-enrolled hospitals and clinics in North Carolina offer specialized weight loss surgery programs that are tailored to the needs of Medicaid recipients. These programs may include additional services such as:
- Transportation assistance
- Childcare assistance
- Financial assistance
- Job training and placement assistance
To find out more about the resources and support services available to Medicaid recipients undergoing weight loss surgery in North Carolina, please contact your local Medicaid office or visit the North Carolina Department of Health and Human Services website.
| Hospital/Clinic | Location | Phone Number |
|---|---|---|
| Duke University Hospital | Durham | (919) 684-2000 |
| UNC Hospitals | Chapel Hill | (919) 966-4000 |
| WakeMed | Raleigh | (919) 350-7000 |
| Novant Health Presbyterian Medical Center | Charlotte | (704) 384-4000 |
| Atrium Health Carolinas Medical Center | Charlotte | (704) 384-8000 |
Hey there, readers! I hope you found this article informative and helpful in your quest for weight loss surgery coverage in North Carolina. Remember, every person’s journey is unique, and what works for one individual may not work for another. If you’re considering weight loss surgery, it’s essential to consult with your healthcare team and weigh all your options. Before I bid you farewell, I’d like to extend my gratitude for taking the time to read my article. Your engagement means the world to me, and I appreciate each and every one of you. If you have any additional questions or find yourself seeking more insightful content, be sure to visit us again soon. I’m constantly updating the blog with fresh articles and resources to keep you informed and engaged. Until next time, keep striving for your health goals, and remember, you’re not alone in this journey.