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Georgia Medicaid

Does Georgia Medicaid Cover Bariatric Surgery?

Dr. Abbas and the team at MASJAX are proud to serve patients in southern Georgia at our conveniently located office in Waycross. Of course, many of our patients wonder if their insurance, specifically Georgia Medicaid, will cover their procedure. Fortunately, the short answer is yes, Georgia Medicaid has covered bariatric surgery since 2022, and through our practice in Waycross, we are happy to accept Medicaid patients. Of course, as with all insurance coverage for bariatric surgery, requirements need to be met before the procedure will be covered. Georgia Medicaid is no different.

The essential qualification criteria revolve around the concept of medical necessity. If the insurance company believes bariatric surgery is necessary for the patient’s continued or renewed health, it is typically covered. In the case of Georgia Medicaid, the medical necessity is determined by several criteria, including:

  1. A primary diagnosis of obesity.
  2. Age 19 and over.
  3. BMI of greater than 35 with one or more serious comorbidities or 40 or more regardless of comorbidities (type 2 diabetes, osteoarthritis, sleep apnea, fatty liver, GERD, and more).
  4. BMI of or greater than 30 with inadequately controlled type-2 diabetes.
  5. Clinical documentation and evidence showing participation in certain medical interventions, discussions of lifestyle risks and expectations, and pre-operative testing.

This list is neither exhaustive nor definitive, so be sure to speak to our office to learn more about the exact qualification criteria for Georgia Medicaid.

Who May Not Qualify for Georgia Medicaid Coverage of Bariatric Surgery?

Certain patients will not qualify for coverage of their bariatric procedure. Of course, this includes anyone who still needs to meet the physical prerequisites for coverage. Patients with certain conditions and diseases like active suicidality, active or recent (within one year) substance abuse, active psychosis, blood clotting disorders, and more may not qualify. Pregnant patients or those planning to be pregnant and those unwilling or unable to follow post-op care instructions may not qualify. These details can be discussed during consultation. Other qualification criteria may need to be met based on a patient’s needs and health status.

This list is neither exhaustive nor definitive, so contact us to learn more about contraindications for bariatric surgery coverage for Georgia Medicaid.

Of course, our number one concern as bariatric surgeons is safety and effectiveness. As such, we take great care in ensuring our patients looking for bariatric surgery are suited to the procedure.

Is Gastric Sleeve Covered Under Georgia Medicaid?

Yes, the gastric sleeve may be covered by Georgia Medicaid in qualifying patients. The gastric sleeve is our Georgia location’s most commonly performed bariatric surgery. The gastric sleeve, also known as sleeve gastrectomy, is a combination restrictive/hormonal procedure offering excellent potential results. Its simplicity and effectiveness have made it the most popular bariatric surgical procedure in the United States.

Does Georgia Medicaid Cover Gastric Bypass?

Some patients will be better suited to a gastric bypass versus a restrictive procedure like a gastric sleeve. This is especially true for patients with uncontrolled or poorly controlled reflux (GERD) or type-2 diabetes. As such, if we determine that a bypass is the best surgical option, it is likely to be covered by Georgia Medicaid.

Does Georgia Medicaid Cover Other Bariatric Procedures?

You may have been made aware of procedures, such as the duodenal switch and SADI, during your research. These are exceptionally effective procedures, especially for patients with very high BMIs. Georgia Medicaid does not currently cover them. However, some patients may wish to consider cash payment for these procedures.

Does Georgia Medicaid Cover Revision Procedures?

As with most insurance coverages, revision procedures are considered case-by-case. Why would one need a revision procedure? Ultimately, not every bariatric patient will be successful. While a procedure failure is rare, patients may commonly stretch their gastric pouch over time and begin to regain weight. We can usually arrest this weight gain with proper aftercare before it becomes problematic, but for some, a follow-up surgical procedure is necessary. Revisions are typically very successful, and patients should speak to our office if they have gained a significant amount of weight in the years after their bariatric procedure.

Ultimately, we encourage any patient with Georgia Medicaid to speak to our office and understand more about the qualification criteria for surgery. We have dedicated billing specialists to help determine whether you qualify for surgery and guide you through the preoperative process. Our goal is to ensure the smoothest administrative experience possible.

We look forward to meeting you at our Waycross, Georgia location and helping you improve your health through safe and effective weight loss surgery.


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