Wisconsin Medicaid

Looking for anyone who has experience getting Wisconsin Medicaid to approve their surgury.

I don't have medcaid. I have only medicare but I spoke with Medicare today and they gave me a number for medigap which is 800-242-1060 for the state of Wi. I am suppose to call and ask to have an insurance advocate assigned to me. That way when I call with questions I will have one person assigned to me. I am trying to get my secondary insurance approval for the lapband. Since you can't get preapproval for medicare I have to make sure my secondary approves it. So far they have denied me for lack of documentation. Using an insurance advocate they would do alot of the dirty work so to speak for me. I am going to be calling tomorrow or Friday. Don't know if it would work for the medicaid or not but hey what the heck, give them a call. I have been on disability for 18yrs and was just told today that this is a service that all of medicare patients are entitled to!! Wish me luck. Good luck to you as well, Sandi

I'm on disability and have straight Title 19 Medicaid. I was just approved yesterday. What is it that you wanted to know? Bliss.......... ~Shan~

Kelly, I had Network Health and I had no problems getting approved, that was in Dec 2005. My friend Kathy ahs Medcaid and Medicare and she was just approved yesterday. Her surgery is Feb 6, 2007. If you have questions for me, just send an email.

My request for a prior authorization was denied for gasrtric bypass surgery. I submitted the following for a request for an appeal. I am appealing your decision for denying my medically necessary weight loss surgery by requesting a hearing, regarding the denial of a prior authorization for # 43644 Lap Gastric Bypass surgery. At 42 years of age, I am 5'5" and weigh 250 pounds, which calculates to be a body mass index of 42, which is considered to be morbidly obese, or 100 - 140 pounds overweight. My neck is 16" and my abdomen measures 51-1/2", indicating that I have excessive fat around my abdomen and my body type is an "apple-shape". As medical professionals, you would be aware that my condition is very serious. I have gone from having baby fat to being chubby to a few extra pounds to obese to morbidly obese. I know that diet and exercise aid in weight loss, but as a long-term resolution to permanent weight loss only 5% of people succeed. I have tried Nutri-Systems, and twice I have joined Weigh****chers. I have also been on medically supervised diets with 3 different physicians. I have purchased diet pills over the internet, tried various diets and joined 3 different health clubs. Sometimes I would lose a little weight, but I always gained it back, plus a few extra pounds. Being morbidly obese I suffer everyday trying to do the simplest tasks such as trying to bend over to tie my shoes. Due to the additional weight and bone spurs, my lower back hurts when I stand even for a short period of time and I have terrible pain in my knees when I have to climb stairs. Even walking at a normal pace leaves me out of breath and my heart racing. I have been diagnosed with Poly Cystic Ovarian Syndrome (PCOS). PCOS is associated with increased risk for insulin resistance, type 2 diabetes, high blood pressure, high cholesterol and heart disease. Weight loss plays a major part in managing PCOS and is the line of attack to minimize current symptoms and attempt to delay or prevent worsening of the underlying conditions of heart disease, insulin resistance, type 2 diabetes and high blood pressure. It is possible that PCOS will worsen with age, especially with weight gain. Many obese women do not overeat. It is a fact that when you are insulin resistant your body converts every calorie it can into fat, even if you are dieting. The result is that while the body is gaining weight, the energy cells are actually starving. Diet medications may temporally work, but the weight will return when the medication is stopped. I, along with an estimated 60 million Americans have insulin resistance. One in four of us will go on to develop type 2 diabetes. Being insulin resistant, excessive amounts of free-floating glucose remain in my blood stream until it is sent to my liver and converted to excess body fat. In addition, hyperinsulinemia encourages my liver to produce even more triglycerides, which lead to a series of biochemical reactions with wide-ranging consequences that can lead to a variety of other serious health conditions, such as coronary heart disease, hypertension, diabetes and some cancers. Obese women who have lost weight have shown to have significantly lower insulin levels. Aging and insulin resistance silently lays the foundation of increasing my risk of having a heart attack. Heart attacks and heart disease run on both sides of my family. Both of my grandfathers died of a heart attack. My great grandfather had diabetes and had to have his legs amputated. Two of my uncles had diabetes and died of a heart attack. Three of my aunts had bypass surgery and two others took heart medication. All of the above family members also had high blood pressure. I suffer from depression and many women with PCOS suffer some physical or psychological manifestations of depression. There is some medical literature suggesting a link between diabetes and depression and perhaps that might be extended to early stages of insulin resistance. Another source of the depression is the effect that PCOS systems may have on self-esteem. In addition to being morbidly obese, I also have severe acne and excessive facial hair. Due to the excess weight, I get yeast infections under my breasts and under my abdomen. I have researched gastric bypass surgery and fully understand the all of the risks involved. As my weight increases and my health deteriorates, the risks of being morbidly obese out way the risks of the surgery. I know that gastric bypass surgery is the only way that my health will improve. I am committed to the requirements of the surgery and look forward to losing all of my excess weight and being able to exercise to get my body in shape and stay fit for the rest of my life. I pray that you will use your education and experience and take all of the facts that I have presented to you and grant me the prior authorization that I need to have the medically necessary surgery to save my life. I was granted an appeal hearing which I am still awaiting. Any thoughts on how I should proceed at my appeal hearing?