Pennslyvania Medicaid/ACCESS!!

I found out I have been DENIED for gastric bypass!! :( Sad!!!!!  They said something like since I'm being treated for the conditions I have (High Blood Pressure, Depression, Sleep Apnea, Pre-Diabetes, Asthma, and IBS...they say it not medically necessary!  What the heck is Medicaid (Pennsylvania Medical Assistance/ACCESS) thinking?? 

appeal appeal

It is not medical assistance/access that is making the decision is it? I am wondering if you change your assignment to a different agent/carrier for medical access if it would be different...ask in the major bariatric practices that take a lot of medicaid patients like Univ of Penn, they will know who is best to work with in the medicaid system. I have kids with disabilities who had access cards and for procedures the approvals came from whomever the company was who we had picked for our coverage under medicaid like Keystone, etc...hope this helps.

Wow!  What do they consider medically necessary?!   Can you appeal the decision?  Good luck!

Hey!  Yeah, they are re-submitting it, so we'll see I guess.  Its just extrememly frustrating and sad!!! :(

That's horrible! That makes me very nervous because I have Medicaid/UPMC for you and I just submitted and waiting to hear something back... I hope everything goes well for you!