Reasons for Denial

April, I am so sorry that they have denied your request for surgery. It really gets my goat to hear things like this. Please don't give up. We all are pulling for you. Keep your appointment. You have to just keep jumping through the hoops until they say yes. and as for Susan.............just forget her. She doesn't sound like a very compassionate person. If she lived in your shoes for a couple days............. It is like you said..If you could get the surgery and get healthy, you would be out there working and doing. Just hang in there and let us know how things are going. Carol

April have you thought about chaning you medicaid HMO? You are allowed to do that. If so change your HMO because one of them has to help you out. I think though you can only do it at a certain time of the year.. But look into it.. You have a computer search for which ones that approve the surgery... I wish you luck ...

April, I feel your pain. It took my almost 2 years to get insurance approval to have surgery (BCBS of FL). But finally on Feb 18, 2005 Dr. Haicken performed my surgery. I can't say enough about Dr. Haicken and the support network he has put together. He cares deeply about his patients so he makes all of us go through extensive testing before he will perform surgery. My co-morbidities included sleep apnea plus back and joint pain. I had my orthopedic doctor with a letter supporting the surgery. In her letter she mentioned that without losing a substantial amount of weigh I would probably have to under go back surgery soon. Have you had a sleep study done to find out if you have sleep apnea? Most obese people have it and that should be enough to get approval. Again I want to praise Dr. Haicken. When I first began researching having the surgery I saw two other doctors and went to their support groups. I came to the conclusion that Dr. Haicken was the best doctor for me not only because of his surgical skills but also because of the high regard all his patients have for him. Good luck! Feel free to email me directly at [email protected] if I can answer any more questions for you. Janice

I agree with everyone Sally, get another doctor who will work with you and appeal. My doctor kept writing appeal letters till I got approved. (only took two, but he did write them). Using Jans letter templates give them a place to start. Don't give up, get angry in a good way and don't quit till you get approved. Perhaps someone on this board knows a doc in your area that they had success with. We're here for you!

How irritating that you were denied, when the National Institutes of Health clearly state that this surgery is appropriate for person with comborbids and a BMI over 35, and to obese people with a BMI of 40 and no comorbids! Are all of your comorbids medically documented? My osteoarthritis helped me get approved, other than the osteoarthritis, all I had was high blood pressure and high cholesterol. Do you have any of those morbidities documented? Also look at this ladies profile, she wrote a list a mile long of ways her obesity impedes her quality of life, incorporate some of them into your appeal letter. http://www.obesityhelp.com/morbidobesity/profile.phtml?N=B997120400 She lists 119 conditions! Her letter is also very good. Keep fighting the good fight, you DESERVE to be healthy!!! ~ Trish

April, I am so sorry to read your comments about how you were treated by Susan.....my deepest apologies from the bottom of my heart! I hope and pray that you find the support and assistance you need from the 2nd surgeon. As for your results from Dr. Murr's office don't wait to hear back from them call Spectra (assuming you went through the same surgery clearances I did there). I have had no problems working with Spectra. I was there yesterday for my three week follow up and they had some staff changes but Christa is still there and she is always helpful in my opinion!!! Stay strong girl everything will work out you are being prayed for by so many here at obesityhelp.com. Don't allow depression to win you over. Just so you know I too had medicaid and I sincerly understand how so people can treat you but you just need to stay strong and remember that you are doing this to live and to be healthy.....you deserve that so fight for it!!! If there is anything I can do for you please feel free to email me!