Question for Tracy??????

Hi tracy, it's Debbie Brown...We had the Medicaid conversation before. I got my second denial from Medicaid but it's not all that bad...I did see alot of problems with the first papers that were submitted to them..They had my BMI at 37 instead of 47...37, I wish! And that I was not on any meds etc.. Now my second denial was after I HAD A PAPER FROM MY FOOT SPECIALIST TELLING THEM THAT i HAVE HAD A FRACTURE FOR 3 YEARS AND NEED SURGERY (sorry hit the caps button) and she won't do the surgery until I lose weight..okay for what the denial said....It said that I didn't submit any evidence supporting that fact, all I had was the paper with no xrays, etc.. Then the last paragraph of the letter said... Appellant is advised that a request for gastric bypass may be resubmitted and reconsidered in light of objective medical evidence that weight reduction is medically necessary for treatment of pain and dysfunction caused by ankle fracture......My question (finally) is should I appeal the denial from them and ask for an administrative hearing and bring my xrays and paperwork there or should I have the surgeon resubmit and then have to wait the 6-12 months for approval or denial...I don't want to get my hopes up but it looks like if I could have gotten my xrays in time for the last hearing that they would have approved...I do have an appointment with my foot specialist on the 17th to get xrays done to take or send to Medicaid and to get a better paper from her with a more detailed description of the injury... What do you think? Appeal or resubmit???

Debbie, Since a request for surgery has already been made recently, you must appeal. Which, is a good thing when you think about the super long wait. Actually, I say appeal, appeal, appeal until you get a yes. Definentely get x-rays, letters-you name it, this time around. Several of our patients have even contacted and involved our state senator---with very impressive results. All it takes is a letter! Good luck!!! Tracy Burch

YOU CAN CONTACT YOUR STATE SENATOR AND LOCAL STATE REPRESENTATIVE BY GOING TO THEIR WEBSITE. TELL THEM YOUR STORY, AND ASK THEM FOR HELP. tHAT'S WHAT THEY ARE IN OFFICE FOR...START WITH THE REPRESENTATIVE FROM YOUR DISTRICT, AND THIS INFORMATION IS ALSO ON THEIR SITE. A GREAT PERSON TO DIRECT YOU IN THIS CAUSE IS VICKIE FROM TOLEDO...SHE'S BEEN THAT ROUTE, AND HAD SUCCESS. BEST OF LUCK, THERESA R.