Ohio Medicaid Frustration

I have already been denied my first time from Ohio Medicaid. I had my first appeal last week I just spoke to the R.N who denied me because additional information was needed. I resubmitted all my additional information. Well she told me that she was going to affirm her decision and most likely my appeal wouldn't be overturned. I can't believe these people. I am 26. My BMI is 72, I have hypertension which is under control by medication, I have severe sleep apnea that isn't controlled by CPAP, degenerative joint disease, GERD, and depression & Anxiety. This Nurse from Medicaid had the nerve to tell me that surgery is a last resort and after denial some people get motivated to lose weight. I can't believe how horrible Medicaid is to deal with. Anyone out there have any similar situations?

I'm truly sorry Andrea, keep appealing, just another argument against socailized medicine, If we all had to go through this, would there be such a thing as bariatric surgery?

Hi Andrea, I have been having a difficult time with ohio medicaid as well. My doctor sent them the required paperwork over a year ago, and I had not heard from them. Well a few months back I called to check on things, I was rudely told that they had no record of me or my doctor asking for weight loss surgery. She also told me that I'm probably not even big enough for wls, I just want it as a cosmetic procedure. I said "lady, I weigh over 400 friggin pounds. I can't walk and I can't breath. Would you like to come and take a look at me and tell me if I need it for cosmetic reasons only?" She then said 'well people find out if they put a little effort into it, the weight does come off' So I spoke to her supervisor, who was just as rude and confirmed that they had no information on me. So I know where your coming from. My new doctor submitted all the information AGAIN. So I'm waiting to hear something. My bmi is over 70, I have diabetes type 2, joint pain, depression, anxiety, panic disorder, hypothyroid, high cholesterol....we're in the same boat, I think. I wish you the best of luck with them and please, let me know how everything turns out.

Hi Bobbie, I sent you a personal message yesterday, I hope you got it. Let me know how things are going along. Andrea.

I was denied by Medicaid 5 or 6 times before I got an approval... Fighting them was the hardest thing I have ever done in my life...All I can say is Don't Give Up.. They tried everything to discourage me.. They made me send in Xrays, made me wait a few weeks and then sent them back saying they had to be sent in from my doctor, then my doctor sent them in and they waited a few weeks and sent them back saying they didn't have anyone there to read the xrays and they needed my doctor to send in an xray report stating the findings of the xrays...Well that was what we had sent in 4 months before that they wouldn't accept and wanted the xrays...It is a big game, a runaround they do hoping that you will give up... Get as many different doctor's statements as you can saying that you need this surgery and the reasons. If you have arthritis and need surgery on something (knees, ankle etc) make sure that the doctor states that they REFUSE to do surgery until you lose a significant amount of weight....Feel free to email me if you have any other questions..

Hi Debbie, I was wondering after all your denials how long did it take you to get your final approval, from the first time you applied?

It took about a year... What took so long each time was waiting for Medicaid to get back to us with each denial...I have to give some credit to my surgeons office for resubmitting my papers over and over....I know I was driving my surgeons office crazy because at first they tell you that it can take up to a year just to hear from Medicaid once you submit your paperwork but I got my first denial in three months and then it took them 6 wekks to set an appeal hearing date... Then with each denial I kept calling my surgeon's office ever two weeks to check the status (I know they were sick of dealing with me and kept telling me they would call me if they heard anything) Then each time I would get a new denial I gave Medicaid all the items they asked for and more information about my health problems...I went to a second doctor and gave them papers from him stating the same thing the first doctor said...I really think what made them finally give me the approval was that I was sending papers and having the surgeon's office calling them every few days asking what more did we need to get this approval... And the straw that broke Medicaid's back was a very mean letter from the foot surgeon about how this is her diagnosis and that they were questioning it and she refuses to send anymore information and that she REFUSES to do anything until the weight is off...It was a great letter...and I got my approval within a week of Medicaid getting that letter....I forgot to mention that at one point in April of last year Medicaid approved me (It was a tenative letter from Medicaid to my surgeon's office) and we waited and waited for the approval letter to come and then she called Medicaid and they said the approval had been overturned...So we had to start all over again...It was a long emotional ride... The worst was the way I felt after the first denial.. After about the third denial it was almost funny, all the things they tried and said to get me to give up....I am so glad I didn't and I wanted to at first but I knew that this was my only chance to change my life, there was no way I could do it on my own... Just keep calling people and getting answers and get them all the information they want and more... Get a readout of all the drugs you are on and what it is costing them per month and per year for your prescriptions...Good luck to you!