NO Hope for Ohio Medicaid Patients!

Hello! It's so hard to understand. We live in a country that wants welfare & medical reform but,yet they are not willing to help people who want to get well and work. Ohio medicaid is horrible. they would rather keep you hostage in thier sick little system than see you heal & move on to a healthy,prosperous life that doesn't involve their system or the goverments money. I have 3 young children at home and also supporting an 18 year old daughter with a 6 week old son and 23 month old daughter and don't get me started on what,I think of the child support system inthis state cause they don't give a DAMN! ALL I want is to be healthy & take care of my family! God knows no man is ever gonna help me,medicaid,or anyone else. what am I supposed to do lay down & die? No,wait a minute there's no monet to pay for that either! Signed, MAD AS HELL IN,OHIO! Kelly

Kelly, What did Medicaid say? Richard

Dear richard, First of all I would like to Thank You for your concern. Medicaid basically said",I was too healthy for the surgery and that I didn't need it. Imagine that? I weigh 357 pounds with high blood pressure,hypothyroid,acid reflux,extreme anxiety,osteoarthritis-with pain so bad in,my legs so bad,I can barely walk most days. Picture of health huh? I take 3-800mg. capsules of Ibuprofen a day, 6-50mg.tablets of Tramadol, 1-20mg capsule of Nexium, 3 to 5-1 mg.tablets of Xanax, 4-20 mg.capsules of ibuprofen, 1-50mg tablet of Synthroid a day and sometimes 4-6 extra strength Tylenol. Can you imagine what all that costs a month. The medicaid card pays for it but,you would think that they would want to help me get healthy and get off all this high cost medicine & doctor visits. Medicaid said",I don't have enough co-morbidites. someone told me to get tested for sleep-apnea that 75% of medicaid patients in,Ohio get approval that way. I set up an appointment with a sleep lab on the phone this past Friday. If, this doesn't work,I don't know what I'll do. I refuse to raise my children & grandchildren from a wheelchair. If,I seem bitter,I appologize but,I'm tired of suffering. any suggestions you might have would be truly welcomed. Thank You. Blessings, Kelly

Kelly, I agree 100% with your decision to get tested for sleep apnea. One of the physicians from a sleep clinic that I am familiar with, said that 7 out of 10 people that have a BMI above 30, have sleep apnea. Medicaid tends to approve when you have a BMI above 50 (and unless you are taller than 5'10"-you do, going by the weight of 357 that you listed previously). You must also have 2 documented severe co-morbidities. High Blood pressure, high cholesterol, sleep apnea, diabetes...are what I mean by severe. Since you have already taken the right step in scheduling a sleep study, I want to make sure you know what Medicaid will require from you to recognize that co-morbidity. You must have the study done and then go back for your follow up appointment to show that you BENEFIT from using a c-pap. If you do not provide the follow up study, they will disregard the diagnosis all together. I also suggest having a complete physical. Have your cholesterol checked! Proper documentation of all co-morbidities is essential in obtaining approval. Supply all records from ALL SPECIALISTS, ER VISITS etc... If your BMI is above 60, Medicaid tends to respond even quicker to your request. Good luck, and if I can be of any further assistance, please don't hesitate to contact me. Tracy Burch Cincinnati Weight Loss Center Dr. Trace Curry 866-350-2263

Medicare and Child support is terrible in Ohio. My daughter is also a single mother of 2. She is in school full time. In order to get bennifts she has to work and additional 30 hours a week. That is 70 hours plus a week. We decided that would not be good for her. So she gets no money. She does get alittle food stamps. That is all. The father of her kids is running all over the usa. ( Drug Addict Low Life) He is out beating the system. He only works 2 weeks then stops. He is a low life bum. To sorry to pay for his children. All he was ordered to pay is $50.00 a week. He cant even do that. My daughter is just happy he is out of Ohio. He is a creep. Thank god he is out of our lifes. Best wishes Barb

Ohio Medicaid has a limited list of comorbidities that they look at as warranting WLS. From my understanding, the "best" ones are High BP, High Cholesterol, Sleep Apnea, but I know there are others. The best person to ask is Tracy Burch from Dr. Curry's office. You can contact her, and maybe she could give you some ideas why you were denied.

Kelly, You have every right to be angry.. I went through this b/s for 2 and a half years. Demand a State hearing for your denial. In preparation for that ask your pharmacy to get you an itemized bill for all your medications for the past 5 years, or however long you have been on medicaid and had these numerous health conditions. If you have had Drs visits, ER visits, and hospitizations ask for those itemized bills as well. I know this seems overwhelming and time consuming. But when I showed them how much money it was costing to treat the symptoms of my obesity they started to listen. You are allowed to take anyone with you to your hearing to speak on your behalf. Have friends family members, nurses, Dr if he is willing to talk about how limited your world is because of the obesity. How it affects your everyday life and earning potential. Letters from friends and relatives can be read to the hearing officer. If you have any questions please feel free to contact me. And Please Kelly use that anger to energize you into working like hell to get this approval. Get that sleep study done and make sure you get the itemized bill for that as well. The best of luck to you.. Now get mad, But dont lose faith that this can and will still happen for you. !!!! Love and Hugs, Laura

I am right there with you. I am waiting for my second appeal hearing with Medicaid.. I got a quick denial the first time and then I requested a state hearing and got another denial. I can so relate to your story. I have 4 children at home (13,6,3,1) and have trouble taking care of them because somedays I can't get out of bed due to pain....If you are on medicaid money or foodstamps, get a readout of what they are paying you for a year and add that to the prescription price list...My doctor's price for the surgery is 21,000 and Medicaid pays no where near that...Show then that they are paying more per YEAR on you than they would pay for the surgery and they may listen..Just don't give up...I know after my first denial I started to give up and just figure that they'd keep denying me so why try...But I decided to nag at them (ask anyone in my house I am pretty good at nonstop nagging) this is something that I want and that I need and this is the only way I am going to get this...This is my life and I've never fought for anything, until now. I wish you luck, email me if you want to talk, it sounds like we are in the same boat...

Kelly I feel for ya, I fought with them for 2 years they denied me due to it not being for health reasons. 375 pounds SEVERE-SEVER Acid reflux required 2 meds at times Asthma- Meds taken for this Mitro-valve-Meds taken for this Bad Lungs-Have to be monitored Thyroid out of wack-meds taken for this Back surgery as a child so pain was daily due to weight gain Legs and feet swelled at times I could not wear shoes blood Pressure so high I was told by PCP I was going to have a heart attack- 2 meds taken Poly Cystic Ovarian disorder Sleep apnea-severe but could not withstand testing for cpap machine I took And was bordering on becoming a diabetic I am probably leaving something out but you get the idea But all they thought was I wanted the surgery for was cosmetic reasons. Had it not been for Tracy Burch at Dr. Curry's office I would have given up, wonder where I would be now? Don't give up it will eventually work out for you I know it is frustrating but think about the rewards in the end.

don't give up hope. I was approved through Ohio Medicaid. I am now 15 months post-op. My co-morbs were. Sleep Apnea, Edema, joint pain, asthma and that's it. It's a shame Ohio Medicaid don't have set standards, it's always a case by case matter. Check out my profile I have Medicaids requirements that I dealt with back when getting approval. Also do you have a choice to change providers? Paramount was approving in just a few days. Maybe that's an option. ~~prayers~~ Vickie 11/22/05 349/319/169.5