Wisconsin Medical Assistance

My Primary Care Physician has recommended Gastric Bypass due to health problems worsened by my obesity. After writing a referral letter with all the info needed except for visit with therapist and nutritionist, I got a call from the secretary of Dr. Alden in Wausau, Wisconsin telling me that she didn't want to waste my time getting the ball rolling since she was sure I would be denied by MA. Given my health history below, has anyone been approved by MA with similar health risks? I am 5 ft. 11 in. and weigh 266 lbs. with a BMI of 36. I am taking 2 blood pressure pills to control my high blood pressure and it still runs high at times. I am taking 2 antidepressants for depression. I have mild sleep apnea I have arthritis in mylower back as well as 2 compressed disks Scarring on the left ventrical due to past damage to heart that went undetected at the time. I take 2 water pills due to continual swelling. I have documented proof of weight loss attempts through Weigh****chers, proof of exercise routine, and 6 consecutive months of Doctor weigh-ins showing continual weight increase. Any comments would be greatly appreciated!

Hi Tammy. I can't help you much. Maybe call the insurance office and get some info to help you. Maybe they go case by case if it is medically necessary. Don't give up. Also, check the insurance board and see if yours is listed to see if they have ever covered anyone. Maybe your BMI isn't high enough but co-morbs are helpful in getting approval on a case by case. Good luck and best wishes. Cheryl

Tammy, I have been denied 4 times by MA. I met all of the requirements until they changed the criteria on Dec 13th, 2005. My info was submitted 8 days after the change date. The best thing that I can tell you to do is go to the http://www.dhfs.state.wi.us/badgercare/ go to seach and type in bariatric surgery. Check out what the criteria is. I know that they have since changed it since I have last checked it. I wish you the best of luck. Kimmie