HELP Anyone! Appeal information needed...

Here's my recap...Denied by Medicaid, Now I have an appeal hearing set for Jan 17...The hearing officer will be on the phone...Help! What do I need to Take with me? He won't be able to see the paperwork, so do I have to read everything to him or will I just state my case and send the papers to him to read on his own... I have a BMI of 47 (probably more by now) with only sleep apnea...no diabetes, no high blood pressure.. But I have not been albe to work in 3 years due to fatigue and leg pain...I have the pain and fatique documented but it means nothing to them because it's not a co morbity...I know I don't have much of a chance at this but I feel like this is my only chance and I know all of you have felt the same way..I know I read some things about what mrbid obestiy costs down the road, where do I find this and is there anyone who knows where to find (and I think it was on someone elses appeal) the piece that argues about the quality of life like this...That is my biggest point. I could live my whole life being 300 lbs (and I have for my whole adult and part of my teen life) if I could function. But I can't function anymore. I am so fatigued and in pain that I can't function. I will tell them that but I don't know how to drive the point home that I have never asked for help before and it took alot to decide to have this surgery, and now being denied is like a kick in the teeth.. Any help or suggestions will be appreciated...And prayers! I wish the letter would have come after Christmas, because now I will be thinking and worrying about it through the holiday...

Debbie, Hi. I am the Insurance Coordinator for Dr. Trace Curry's office. Hopefully I can provide you with some information to help you out. You mentioned your BMI is 47 but is probably higher now. Get reweighed asap by a doctor and have it documented. Medicaid will tell you that your BMI needs to be 40 or above, but it's actually 50-from what I see. Another important thing is co-morbidities. You said you have sleep apnea. Do you use a c-pap? If so, it is VERY important for Medicaid to know that you benefit from using the c-pap. Once you were given your c-pap (assuming you use one) you should've had a follow up appt. with the sleep clinic for a trial use with the c-pap. Get those records if you don't have them already. Also, you did not mention anything about your cholesterol. Have you had it tested recently? Even if it's been as recent as 3-6 months ago since your last test--get tested again. Now, you mentioned you had severe pain. Who do you see for that? How have they treated it so far? Also, I would have every doctor you have seen in the past 5 years (OB/GYN, pcp, ortho etc..) write a letter on your behalf--if you haven't done so already. If you have, and the letters are over 6 months old, do it again. In most cases I have dealt with, it usually takes a BMI of 50 and 2 severe co-morbids to get approval by Medicaid. The severe co-morbids they recognize most often are hypertension, high cholesterol, sleep apnea and diabetes. However, since you have 1 and the severe pain, you may be able to pull it off----if you are very prepared. I hope this helps. If you have any other questions, don't hesitate to call or email me. Good luck and Merry Christmas! Tracy Burch Insurance Coordinator Dr. Trace Curry's Office 513-559-2544 [email protected]