DENIED! I am in Shock

I was all ready to wait the 6-12months that Medicaid takes to review the papers.....And in today's mail...A denial letter, THAT took less than 3 months...They say there were no severe co morbities that would warrent this service.....EXCUSE ME? I have been out of work for 3 years because I can't walk....What about my sleep apnea?....What about the fact that I can't function like a normal person or take care of my kids because I am too fat to move without gasping for breath....I'm sorry I am telling all of you this I should be telling them this...I just don't know who to tell...My family didn't support me through this and I am going to hate telling them... I know I can appeal, but for right now I am just in shock...That it was that easy for them to check off the denial box....

Okay I know you are very upset. I know I was the first time. There are many people who have gone threw this with medicaid. You need to get all your doctors hospital records and appeal this you also need to write them a long letter. Send them a picture of you and your kids. Denail the first time around is quite common. You can talk to others about this who have had to deal with medicaid. Just keep your head up. At least you didnt have to waite 12 months to get denied. You can fight this. Your in the system now Take care and dont even tell your family Here is a big hug Barb

Debbie, I am so sorry to hear about your letter. Appeal it. Fight for your right to be healthy. Did you take all the tests needed to be presented to them for the comorbities? I know I did sleep apnea, I had diabetes, EKG, weight history with my PCP. All my lab work showing my blood sugars. A letter from my chiropractor. Just try to think of anything else they can use to help you. I will keep you in my prayers. Hang in there! Hugs, Julie

Thanks for the suggestions. I was proud at my surgeon visit that I had all my paperwork... But the problem with me is that I don't have the co morbities that they need to approve... My BMI is 47 and I thought that and the sleep apnea would be good, they don't count the fact that I am not able to walk or stand because you can live for years like that...I don;t have diabetes or high blood pressure...I will appeal, but I'm not getting my hopes up

(((((((((( Debbie))))))))))) FIGHT em, this is YOUR life, not theirs.

Hi Debbie. I am so sorry that you were denied. I'm sure you're feeling a bit numb right now but when the anger hits, get out a piece of paper and start writing down all the reasons you feel you need this surgery. Then contact your doctor (surgeon) and meet with him/her and see what you can do together to get this approved. If it means more testing and more documentation, go for it. As others have said, this is your life and your health. If you don't fight for yourself, no one else will. Good luck!

Debbie, I am so sorry about your denial. Take a couple of days to mourn, then get ready to dig in. I was denied by my insurer 3 years ago for not having a bmi of over 40 for 5 years. I went all through the appeal processes...still no luck. Now here I am trying again (I now meet their "stinkin" rule. I know I stand a good chance of being denied again, but I will fight, fight, fight and I'd like to hear that you will too. Find out exactly how their appeal process works and plan you attack from there. I know everyone here will be more than happy to help you in any way possible. Chin up....it's NOT over.

Not to hijack Debbie's thread or anything, but Diane ~ I am so sorry that you have had to go this long without being approved! That is awful. Too bad you weren't able to change carriers. I am really sending you positive vibes for this approval!

Debbie, Understand I am not reading any other posts back to you yet. I want to give you my fresh opinion on this. My personal feeling on this is that its a blessing in disguise that you got your denial so quickly. So Now you can get started on the Appeal stage much faster. I was denied 2 times by Ohio medicaid with Cardiomegally, Restrictive cardiomyopathy, asthma, Severe sleep apnea, high blood pressure, high cholesterol and triglycerides, pre diabetic conditions which warranted meds, arthritis, cushings syndrome, severe edema, gastric reflux disease, depression etc. I had a file 3/4 inch thick that each time my Drs office submitted to the Review Board. I had 5 letters from 5 different Drs, physical therapists etc. My file contained hospital and office notes and I had my pharmacy run a printout of all medications used during the period from my initial application until my court hearing date for appeal number 2. I think that the printout impressed them more than anything when I showed them and spoke with the hearing officer about how MUCH medicaid had paid out in medications that most likely would be greatly reduced by having the WLS and getting off certain meds. Also I had the hospital run a total of all the hospitalizations, treatments, tests, ER visits during that time period. Showing them if left unchecked my obesity would eventually cost them more and more down the road and more likely the $$$ would go up each year I aged. Then it is your choice what else you present at your appeal hearing. You can have friends and family speak on your behalf and how they see and feel the obesity affecting your quality of life. My son came to my hearing and read a letter about how much he was missing from a mother who couldnt physically be there for him. How it was affecting him emotionally. The judge let him read and asked to turn off the tape. He said.. Off the record I am approving your case. So my best advice to you is to make sure your records contain as much as possible. You may request a copy of everything submitted from Medicaid. They have to give it to you. Send a written release to them requesting your records. Look over everything in your file. Maybe some of the Drs didnt send in all the required info. I found that to be the case with me. They didnt send in all my documents about my attempted medically supervised weight loss etc. Also. Not all the results of all my tests and hospitalizations were there. So spend a week or so looking over everything. Send copies of any records you have. Sign the required forms requesting a state hearing immediatly. It will take a little while, but really it was just long enough in my county for me to get all my little duckies in a row. Present your case calmly but with feeling. Let them know how much being overweight has burdened your life. Tell them of all of your attempts and how you want a better healthier life for yourself. Send everything back to the review board quickly and go from there. With Gods help you can get it approved this first time. Also there are attys who will help with appeals if you can afford it. I represented myself. But please remember that you can take whomever you want to speak for you the day of the appeal. Family, friends, Drs, therapist etc. I wish you the very best of luck in everything. And if you need any more help or have any more questions I will gladly help you. Loving hugs Laura