I Wanna CRY!!! Please Help ME!!!

Today i recieved my denial letter to have surgery, I live in Washington State. They said they think they surgery risks are greater than my health issues. Like they live in my shoes right?! I have been working towards this for almost 2 years now just to have the door slammed in my face yet again. I have been crying my eyes out since i recieved the mail today. I have Medicaid and am in the state of Washington, so i am trying to figure out how to go about appealing and what i need to do whats the best things to have included in my appeal. I'll be damned if i am going to die and leave my children motherless. I need this surgery, i know in my gut if i don't get it i will die. I have that feeling if any of you know what i mean. That gut Feeling!! Anyway, daily my health is falling fast and i am trying to get everything together that i possibly can for my appeal, i need it to be the best it can be to fight for what i need so i am looking forward to any suggestions and responces, good or bad, lay it on me. I rather be to prepared than not enough. Much Love and Respect, Michelle

DON'T GIVE UP MICHELLE! That is the best advice I can give you. I was denied once too. I was not going to take no for an answer. I don't have Medicaid. But I hope someone has some advice on how to appeal to them. Lots of people have went the lawyer route too. I am not sure what all is involved in that but it might be something to think about if you appeal and are denied again. Write a heartfelt letter to send in with your appeal. I can email you the letter I wrote if it would help you to know what to put in yours. Keep your chin up girl. And let us know if there is anything else we can do to help you! Lori

Hi Michelle, I was denied once too. I think they sometimes do that just to see if you really mean it. Keep trying. When I went in the second time, I made a list of all the things I had tried and another list of all the negative ways my weight was effecting my life. My PCP commented on how organized I was. I think it really helped too. Good luck, Carol

michelle- don't give up, it is a common practice to deny people coverage because they hope you will give up and they don't want to pay. it is not personal, even though it feels like it. It is a game to them and you have to hang in there. They see it as the longer they can keep the money the better for them. You do need to make lists of things you have tried (weigh****chers, etc)and when. if you can get medical records from your past doctor's showing the weight yo yo ing you have experienced that will help (legally your past and present doctors have to release a copy of all your recorfds to you- just ask) and finally there are attorneys who specialized in fighting denials. You are absolutely not at the end of the journey. As long as your insurance does not say in their disclosure that they will not pay for bariatric surgery for any reason then you have a good chance - brandi

APPEAL!!!! I was denied by WA Medicaid in 04. Don't give up. If possible get letters of support and medical necessity from your PCP and all other specialists you have worked with. Ask them to address the risk v.s. benifit issue directly in their letters. You should also write a letter of your own addressing how your wt. effects you including things you can no longer do, your ability to work etc. You can also collect data about your medical conditions to prove that this surgery does resolve or greatly improve them and if left untreated can leave you disabled or impaired in some way. You may have to go to a hearing and present your side. It would be great to have a lawyer to present it for you but lawyers are expensive so don't be afraid to do it yourself. It will be worth it in the end. The worst that might happen is they say no again and even if they do you will feel better knowing that you have done all you can. I believe that if you are persistant they will approve you for stage 2. Best Wishes ~Holly

Hi Michelle, I love this website. Everyone here wants to have wls or has already been through it all. There is such great support and advice here as I too have turned to OH for help, advice, and answers. I am too on medicaid and SSI. I am still trying to get whatever I can and whatever else I may need that I am not even aware of yet together so I can have my first letter sent in for approval. I have been wanting this for almost a year and a half. I have thought about e-mailing you before because not only our you on medicaid but you live in the vicinity of Wenatchee. I live in Chelan. I was thinking that maybe one day we could help each other. I have been thinking of you Michelle since I read what you wrote here a few days ago. I haven't been able to get this off my mind. I know I may face this too one day. My heart goes out to you. I started looking under the insurance forums. I checked out other people who were denied and some of the ones who appealed. I noticed that some people, no matter what state they were in, turned to Obesity Law and Advocacy Center. There was even a lady in our area, Waterville, who mentioned the names of Walter and Kelly Lindstrom to help her with her appeal. I tried to find there names in the phone book. No luck. So I searched their names online and it linked me to again the Obesity Law and Advocacy Center. I checked out their website and I think...I hope that this will help you Michelle. Check out, "How To Get Our Help" by going to www.obesitylaw.com/assist.php. Also, look into this website too, www.healthlaw.org. I had saved this site a long time ago under my favorites that I got off of one of these forums. They help people with low income. Maybe someone will take you as a probono case (where you don't get charged.) Please keep me informed on things. I sure hope you can find the help that you need to get that wls. Keep your faith up and don't let them discourage you. I am one that needs to hear this too because I have been very down about the process. Also, not having a pcp who knows what she is doing. My previous doctor got one patient who also was on medicaid approved. I got a copy from her of the so called letter that she wrote to medicaid and it was a short note of a few sentenses trying to get me approved. She told me that they denied me a long time ago. I got very upset and choked up. I never received a deniel letter. I never heard her even talk about sending in a letter. I knew she didn't know what she was talking about. She had a nurse check my records and they came across this so called letter to medicaid. Then she said she never got a answer from them and she had done this last Aug. 2005! I never knew until last Monday, July 17th about any of this. She was all frusterated about it all and told me I would be better off paying for it out of my own pocket! Can you believe that??? Yeah right! I am low income...hello! It was my last visit with her because she moved out of state. My last appointment and the most disappointing one I ever had with her or any doctor. I thought she was trying to help me. I thought she was a good doctor and had even referred her to people. I couldn't even talk about it to tell my fiance or my mom how my last visit went with her until the next day. I was so upset and in shock realizing that she wasn't helping me much all along. I couldn't believe she told me I'd be better off paying for the surgery. Now you are the third person that I have told. And it has been 5 days now. Sorry. I guess I was ready to lay it all out there and get in off my chest a little more. I sure hope I was some help to you Michelle. Keep me in touch and feel free to e-mail me anytime time. All the best of luck to you! ~*Debbie*~ P.S. WOW! I have never added this much on any forum before now.

michelle one more thing is that I am not sure what kind of surgery you are trying to get paid but lap band is so much less risky than others and you may do better trying for that. go to a lapband discussion. that is where i learned about mine. dr montgomery gave the one I went to and he did my surgery, it's free and i highly recommend them. good luck