Appeal Procedure Help
I was approved for DS surgery by Manitoba Medical only to have the program in Saskatoon close down just before I was scheduled for surgery. DS surgery is now no longer available for Canadians unless you are in Quebec. I applied for approval to have surgery with Dr. Anthone in Nebraska and they rejected me in a letter today. I have 30 days to appeal. I am looking to hear from someone who has had to go through the appeal process to see if I can get some pointers. Thanks.
candyspice
on 9/29/08 3:12 pm - ON
on 9/29/08 3:12 pm - ON
its hard getting approval for out of country but if you wanted to message me and leave me your phone number we can talk and I can try to help you with out of province...
hope you much luck in your journey though if you get approval
hugs for now
Candy
hope you much luck in your journey though if you get approval
hugs for now
Candy
Hi Candy!
You can reach me at [email protected] and I'll send you my phone number. Thanks so much for offering to help. I really appreciate it.
Cheers,
Sue
You can reach me at [email protected] and I'll send you my phone number. Thanks so much for offering to help. I really appreciate it.
Cheers,
Sue
candyspice
on 10/4/08 9:39 am - ON
on 10/4/08 9:39 am - ON
quote"I applied for approval to have surgery with Dr. Anthone in Nebraska and they rejected me in a letter today."....can you clarify *****jected? was it the Dr's office or Manitoba Health? thanks:
p.s. I sent you my home phone number via email :)
hugs
Candy
p.s. I sent you my home phone number via email :)
hugs
Candy
Hi there
I went through the appeal process, what a ride! My appeal was for extra travel subsidy as manitoba health only will cover 3 flights. Initial consultation, surgery flight, and one post op, if required, as if its not required! I am seeing Dr. Starr from TO *****quires several appointments. First being the consult, that was covered by MB health. The second was the social work, dietary consult, that was not covered for travel subsidy. The third being the Feeding class and the internal medicine consult, which i will attend this thursday. I appealled the last two flights and i won!! It was a very intimidating process, i was in front of an independant appeal board which consisted of 5 people, one being an MD, a lawyer, an accountant, a nurse and one other lady who i am not sure what her role is. Manitoba health sent a lawyer and an md to represent them. I went with my mother. The lawyer for MB health was very lawyer like and i felt lost with some of his questions. But the lawyer on the appeal board was very helpful and really went to bat for me. I felt like the appeal board was on my side right from the start, trying to find any loop holes in the health act that they could. The appeal board succeded and found the loop holes that i needed to get the travel subsidy for my last two flights. The appeal board is really inpartial and do not work for manitoba health so the appeal was fair and unbiased. I think manitoba health rejects all americal referrals because they have a different fee schedule than canada does. Also similiar procedures are available in canada so they wont even consider a US referral. I heard that the saskatoon program has now reopened. i got an email a while back stating this. You should try Dr. Starr from TO. I started this whole process in march of 2008, saw dr. starr in may. 2008, saw the diectican and social worker in August of 2008 and am leaving on thursday, october 10/ 2008 to have my feeding class and medical internist appointment. I know that i will have to back one more time to be seen at the pre screening clinic at humber river hospital and see Dr. Starr at the same time. Hopefull, with the grace of god, i will be cleared for surgery and get a date. Hope some of this helps.
good luck
Louise
I went through the appeal process, what a ride! My appeal was for extra travel subsidy as manitoba health only will cover 3 flights. Initial consultation, surgery flight, and one post op, if required, as if its not required! I am seeing Dr. Starr from TO *****quires several appointments. First being the consult, that was covered by MB health. The second was the social work, dietary consult, that was not covered for travel subsidy. The third being the Feeding class and the internal medicine consult, which i will attend this thursday. I appealled the last two flights and i won!! It was a very intimidating process, i was in front of an independant appeal board which consisted of 5 people, one being an MD, a lawyer, an accountant, a nurse and one other lady who i am not sure what her role is. Manitoba health sent a lawyer and an md to represent them. I went with my mother. The lawyer for MB health was very lawyer like and i felt lost with some of his questions. But the lawyer on the appeal board was very helpful and really went to bat for me. I felt like the appeal board was on my side right from the start, trying to find any loop holes in the health act that they could. The appeal board succeded and found the loop holes that i needed to get the travel subsidy for my last two flights. The appeal board is really inpartial and do not work for manitoba health so the appeal was fair and unbiased. I think manitoba health rejects all americal referrals because they have a different fee schedule than canada does. Also similiar procedures are available in canada so they wont even consider a US referral. I heard that the saskatoon program has now reopened. i got an email a while back stating this. You should try Dr. Starr from TO. I started this whole process in march of 2008, saw dr. starr in may. 2008, saw the diectican and social worker in August of 2008 and am leaving on thursday, october 10/ 2008 to have my feeding class and medical internist appointment. I know that i will have to back one more time to be seen at the pre screening clinic at humber river hospital and see Dr. Starr at the same time. Hopefull, with the grace of god, i will be cleared for surgery and get a date. Hope some of this helps.
good luck
Louise
Hi Louise!
Thank you so much for putting things in a better light for me. I didn't have a clue about what to expect and now I totally understand that the Appeal Board is actually going to work in my favour on my behalf. That makes me feel a bit better.
I think you may be thinking of the Regina group that has started a 15-month pilot project offering only the gastric bypass to those patient who were left high and dry by the Saskatoon program. At this point, I am totally unaware of a program being offered out of Sasktoon.
What type of surgery does Dr. Starr offer? Good luck to you with your quest to get to the other side.
Cheers,
Sue
Thank you so much for putting things in a better light for me. I didn't have a clue about what to expect and now I totally understand that the Appeal Board is actually going to work in my favour on my behalf. That makes me feel a bit better.
I think you may be thinking of the Regina group that has started a 15-month pilot project offering only the gastric bypass to those patient who were left high and dry by the Saskatoon program. At this point, I am totally unaware of a program being offered out of Sasktoon.
What type of surgery does Dr. Starr offer? Good luck to you with your quest to get to the other side.
Cheers,
Sue
Hey Sue
Well, i am in Toronto right now as we speak, just had my appointment with Dr. Glazer, who is the internal medicine physician, he has just cleared me for surgery, Yayyyy!! Now i await an appt for my pre op and to see Dr. Starr for a surgery date. I heard while i was here that once you go for the pre op it is only good for one month so that means surgery within that month, which sounds great to me. Dr. Starr does the Roux en Y gastric bypass. This procedure seems to be the most common and has the best success rate. Any other questions feel free to email me. I have several people from this site many questions so makes sense that we all share what we know. Knowledge is power!!!! take care and good luck.
Louise
Well, i am in Toronto right now as we speak, just had my appointment with Dr. Glazer, who is the internal medicine physician, he has just cleared me for surgery, Yayyyy!! Now i await an appt for my pre op and to see Dr. Starr for a surgery date. I heard while i was here that once you go for the pre op it is only good for one month so that means surgery within that month, which sounds great to me. Dr. Starr does the Roux en Y gastric bypass. This procedure seems to be the most common and has the best success rate. Any other questions feel free to email me. I have several people from this site many questions so makes sense that we all share what we know. Knowledge is power!!!! take care and good luck.
Louise
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