Help needed with Judge's letter

sandy N.
on 2/26/05 8:21 am - kevil, KY
Well, it has been a looong 6 mos. I recieved the judge's letter today giving me an reversed on the denial for the gastric by-pass surgery back in May. The hearing was on Sept. 3rd and I am just now hearing from the judge. I also got a letter"Exceptions to Recommmended Decision" from Medicaid's attorney. This is what their letter stated: The Department for Medicaid Services, through counsel, files the following exceptiions to the recommened order in the above-tyled case: The ruling of the hearing officer does not adequately consider the evidence in the record that Ms. Nelson was capable of effective weight loss without gastric by-pass surgery. Ms. Nelson testified that she re-gained the weight after she stopped dieting. What is required of Ms. Nelson is a change in life-style. Weight control is a lifetime endeavor which requires self-discipline in order to maintain an appropraiate weight. The appellant does not have the self discipline to maintain good dietary habits. What is required of Ms. Nelson is a clear understanding of what healthy choices mean. A conversation with her family doctor and the nutritionists who have tried to help her with active listening on the part of Ms. Nelson is what is required-not gastric by-pass surgery. This surgery is not medically necessary. Gastric by-pass surgery is a drastic and sometimes dangerous procedure which can result in the death of a person subjected to it. It is neither comsmetic nor the panacea which Ms. Nelson believes it to be. It will not replace self discipline in a battle to control weight. Ms. Nelson has demonstrated the ability to lose weight without resorting to this procedure, and assuming the responsibility for the manitenance of a healthy lifestyle with good choices to reduce and to control weight is what is needed and preferable to an invasive surgical procedure which will not slove and may only add to the gravity of the appellan's unfortunate situation. Now, the judge wrote:Recommended Decision Based on the forgoing gindings of fact and conclusions of law, supra, it is herby Recommended that the May 26, 2004 decision of National Health Services, on behalf of the Department for Medicaid Services, denying Shandra Nelson coverage for the requested service of inpatient bariatric surgery be REVERSED. This is a Recommended Decision. Pursuant to 907 KAR 1:563m Section 9, exceptions to this decision may be filed within fifteen days of the date of this decisiion. Exceptions should be filed with the Cabinet for Health and Family Services. A final order shall be issued pursuant to KRS 205.631(3)(b). This was dated on the 23rd of February, and the attorney's was dated on the 24th of February. Now, what I was wondering, will I have to wait for a final order since the attorney is against me having this surgery, or is the judges letter good enough to go ahead and let the doctor know that I was approved. If anyone out there has had this problem or could help me out with this please email and let me know asap. My private email address is: [email protected] I am confused over this whole thing. Am I approved or what?
Shell G
on 2/27/05 11:02 am - Home Sweet Home, KY
There is a attorney that had gastric bypass in tn i believe he frequents the site. You could go to the main board and ask his name wright him and ask him. It is confusing to me too. IMO I would say you have to wait for the final decision. But i am no lawyer. I wish You the best and hope you are approved if it is what you want. 287/198/150 Shell
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