Has anyone fought Medicaid insurance denial

Hi Everyone,    I am on a 2 year battle with medicaid for approval for GBS. I keep getting denied as "Not medically necessary" I am now waiting for a date for my 2nd appeal with the judge.( I had 4 previous denials, then it goes to the judge.)  If you check out my blog you will see that I more than qualify for it. If I had any other insurance I would not be having these issues. In fact I think my BMI of 60 would alone qualify me. They keep saying that my meds are controlling my co-morbs so therefore I do not need surgery. It does not seem to matter that I have elevated liver levels because of them or that I am gaining about 20 pounds a year from the meds. I actually should have stonger meds, but I can't risk increasing my weight even more. I have high BP, high Cholestrol, Diabetes, Sleep Apnea, severe joint issues, and I have provided letters from 5 different Doctors and Surgeons stating that this is medically necessary/ and or in my best interest to have GBS. It all seems to mean nothing. They keep delaying me, they ask for this and that, and then it takes 3 months to get it, and then all they do is send me the standard denial form. I do not know what to do. Has any one actually fought the state and won? Any suggestions would be greatly appreciated. My heath is rapidly decling as they keep jerking me around.

What is a GBS? I have title 19 hmo of united health care(badger care),I am still in pre surgery. I have one month left of the 6 months required then goes to surgeon then to insurance. i hope I don't have that trouble. Could it be the procedure that they don't want to cover? Do they cover the rny? That is crazy that you can't get this. ugh. Wish you alot of luck.

Robin

GBS is Gastric Bypass Surgery.  I was told by my surgeons office that it seems to them that title 19 seemes to have better luck with getting approvals. Good luck.

Do you have a lawyer helping you through this process? I was denied the first time,  went before the judge to plead my case. He still denied me and I appealed that decission.  In the process of them finally looking at the paperwork they were sent the second time, I obtained  a lawer. I also kept getting the "not medically necessary" letters. I didn't even need  for him (lawyer) to do anything for me. I think it was the signed peice of paper saying that I had obtained a laywer and I wasn't going to quit trying for this procedure. DO NOT GIVE UP!!!
JudiCare is a state run program for low income people who can not afford legal representation. If this is the case please call them ASAP and ask them for help. Good luck to you and I'll say some prayers in hopes that this all will work out for you. I again repeat DO NOT GIVE UP!!! My surgery was May 12 and I feel better already, and you will too.
Another thing that I did when I was fighting these appeales was I called them 2 or 3 days after I mailed them something to make sure that they had received it in the mail. 9 times out of 10 they told me they recieved it and told me the next thing they needed. It usually was in the mail BEFORE I recieved the letter from them telling me what they needed. It spead the process up and I think it made them sick and tired of hearing from me. Good luck.

I will check out JudiCare, thank you. But I was under the impression that you could not get a lawyer to help you with the state. I wonder if just telling them that I am seeking legal advice or representation would help. Can I ask what it cost to get that signed paper you mentioned? I am about out of hope here. I wish you a speedy recovery! Thanks for your response

JudiCare  is free representation for low income people. It does not cost a thing, but you'll have to do all the leg work for getting the lawyer. JudiCare will send you a list and you have to obtain a lawyer on that list for them to cover the cost. I did my interview over the phone, and never had to travel anywhere.
I've never heard of not being able to get legal representation to fight the state. That is not true. I do not believe that just telling them you are obtaining a lawyer will work. What happens if it does go to court and you don't have represntation? Then what? Never cry wolf.
I said it before and I'll say it again DO NOT GIVE UP! That is what the state want's you to do, so they don't have to pay for the procedure. They deny people all the time, but if you persue it and stay on their a**, eventually they will give in. It was very hard and depressing getting the "loser letters", but fight it.
You need to get your PCP on your side, have them write letters that this is medically necessary. My Dr. practacally had me dieing the next day. Dig the hole here I come. I laugh about it now, but holy crap, after reading the letters he wrote to state, I felt even worse!
Good luck with this and if you have any more questions, ask, I'll be checking back here soon.