Denied Today on first appeal

Hey Yall.. I am going to have my pre-cert nurse resend in the exact same thing she sent in before. There is nothing more I can give them. I am going to contact Vocational Rehab as soon as I can figure out how to find their phone number. Any help would be greatly appreciated. I live in Forrest County so that number would be even better. I cannot afford to pay for this surgery out of pocket and I am meeting with my nutritionist again on SUNDAY. Yes, Sunday.... I will get him to start me on a diet that he can actually document. I will try it for 6 mos and if Voc Rehab doesnt work out then I will reapply in Feb to Empire Blue. My biggest problem has been the way I have been moping around and not really paying attention to my family. This surgery has consumed my life. I have to get out of that. I made a promise to my husband this morning that I was not going to let it upset me anymore. I am going to stay and fight the good fight because if I dont - they will do this to someone else. I talked to a guy I work with yesterday and he told me he did not have to give them the supervised diet history and we are on the exact same health plan. This will be my appeal to them. Treat me like you treated him. Fair is fair and I should be treated no different. Arlies, I would love to talk to you or any of you for that matter. Its so hard to come here and watch everyone say they got approved. Although I am happy for everyone else, it makes me sad for myself. I am in a 'pity myself' mood today... haha... I think I need nerve pills. Anyone with more info or phone number to voc rehab -please email me. I will call Dr. Blakes office today and see what I can find out. What is the deal with his office that you can get it paid for? I dont understand and elaboration would be great. Thanks guys for the inspiration. I appreciate it more than you know!

Just wanted to let you all know that I called Vocational Rehab and she said they do cover it but that it might take up to a year. She also asked me if I work. I told her yes and asked if it was a problem. She said this surgery is usually reserved for patients who are not working. I pushed it and she told me to call Dr. Blakes office. When I called his office I spoke with Daphne and she didnt seem real helpful at all. I promise she sounded like I was bugging her and that I should not have called. I got her fax number and am going to send all information into them tomorrow. Hopefully - I can get some assistance this way. Maybe the good thing about this is that I can get it done Lap instead of open. That would be great. Keep me updating you guys on all you have been thru with Voc Rehab and Dr. Blake. I dont know what to expect AT ALL! Thanks!

Well, Daphne must be having a bad day! She is usually really nice. When you go for your initial consult with Dr. B, he gives you reams of paperwork including voc reb and a financial assistance form. I don't know how the financial assistance form works or who the assistance is from - I don't know if it's a pay back or a grant, but he'll give you all the paperwork that they have. Please email me your phone number. Also, Dr. Salameh works there too, and I believe, unless things have changed, his wait list is shorter and he SPECIALIZES in lap. So check with him also. You can reach his office through the main number at UMC. Keep on keeping on...we can all do this together! Love ya, Arlies

She just seemed frustrated that the lady at Voc Rehab referred me to her. She said I needed a referal from another doctor. I told her what all I had already done and that my current surgeon does not take Voc Rehab. We will see what works out. Cant wait to talk to you! I emailed you my numbers.

christine, arlies, The financial assistance is provided by UMC for assistance for patients that dont have insurance. They go by you household income (with me its a household of 3 with and income of around 20-22 thousand a year and I am approved) I had my lung test today and the patient financial assistance covered it...i had to pay nothing....it is not a grant or a loan you dont have to pay any of it back...when you get your application all you need is a copy of your last years tax info, at least 2 pay stubs of the person(s) in the house and Dr. Blake will send them your letter of necessity...those are the things you will need. Daphane must have been having a rough day because she is usually really sweet...and I can attest for the Medical Mall being swamped today..I was there and I was near the clinic where she is and it was super busy in there today. So please dont be discouraged because of that...Dr. Blake and Dr. Salhame will help you it may take several several months before you can see them (I had to wait 9 months before my appointment came around...i made it in august of 2003 and they game me the appointment of May 25, 2004) so dont get discouraged because of the long wait for an appointment..he is just that darn good!! everyone in the state wants him for a surgen...just keep on keepin on they will help you! Love yall, Angela Blount

Hey Christine, I agree with everyone else , if this is something you really want for yourself don't give up so easily .Don't let them (insurance company) win.There are too many ways to be able to accomplish your goals to give up on it now...........Sherry......

Thanks you guys... I truly appreciate all the input. I have given several of you my phone numbers and I would love to talk to you. I am hoping this will work out. The only hope I have left is this voc rehab. If not, I will wait my 6 mos and try again on insurance. Thanks to you all...

Hi Sherry and Angela, I just wanted to let you all know that my pre-cert nurse called me today and she faxed me everything she had that was sent to insurance. I turned around and faxed all of that to Dr. Blakes office. I dont know what will happen next. I dont know how long it will take. I dont know what to expect. I also meet with the nutritionist on Sunday and will give the 6 mos a whirl-and refile on ins in Feb. Whichever comes first I will grab. I do not think I would qualify for the assistance at UMC since I am married and we both work. But, I will give it a shot. Keep talking to me people or I will go crazy again! Bye yall! Christine

Hi Christine, I believe that I read the MS is piloting studies on Obesity and WLS. Due to the high incidence of MO in our state, a state agency was providing $$ to assist in paying for WLS. It sounds like this may be the grant where the funds are coming from for the assistance. Try not to get discouraged. We should schedule a lunch to chat since we both live in HBG. Heck, we've probably already seen each other at WalMart, church or school. Hang in there, everything happens for a reason we just don't always see the reason until the trial is over. My prayers are with you. Elesha