finding strength to deal with the waiting game!!

I have tried for many years to loose weight naturally. Personal trainers, diets, ect... But I only saw limited results and always gained the weight back. In 2001 I broke a vertebre and ruptured a disc(L4-L5) which required a major back surgery to repair. I went back to work heavy manufacturing in a plasitcs factory 3 months early because of job reduction and company restructure. I soon found out that I could not stand for the 12 hours shifts anymore and was forced to quit and look for less physical work. I was leading a more sedative lifestyle and gaining weight hand over fist. I reinjured my back and it will require more surgery if i dont loose weight and I developed many weight related illnesses such as diabetes,severe sleep apnea, high blood pressure and high chelosterol. My family doctoer called me and told me I was at as large of a ricks for heart attack as someone who has already had one. I said to myself that was enough and decided to do some thing to prevent early death. I saw a WLS surgeon after 2 month of research and questioning other bariatric patients and after my research phase I had renewed faith in life. I deciseded to do what ever it took to have WLS. I went to the physc evaluation and that doctor told me I was a great candidate and gave me the recomendation to have WLS, I saw the surgeon and his assistant and both doctors told me I was a great candidate because of my comorbities and having a BMI of 41.6. He said I could expect to loose up to and over 100 pounds, eliminate the diabetes, hypertension and high cholesterol. I had a sleep study and was told I had severe sleep apnea nad should use a CPAP machine to help get a good nights sleep and prevent choking during REM sleep. I had an endoscope and I have been to several group support meetings. I know the risks of WLS and I know that if I dont have WLS my life will be drastically less productive and fulfuling. In the begining of June my provider sent in my paper work it was sent back for corrections and sent back in then 2 day later it WLS was denied because of a Medical neccessity clause in BadgerCare. My provider told me to gather more info and she would resubmit and see what happens. I did not have enough info in the package sent in the first time to prove my comorbities. I gathered all records of my illnesses and she resubmitted July 5,2004 and again it was sent back for more info on the 7th. she corrected the problems and now I am playing the waiting game again. I am so anxious and ready to pull my hair out. I am so afraid they are going to deny me again I dont know what to do. I have called them several time to find out about status chance and I get a diffrent answer every time. They give me the run around. I dont want to wait 6 months to a year to appeal please if there is anyone out there with info on recent BaderCare denials or approvals please share any info is greatly apprieciated. Thank you, Pj Manning P.S. Keep me in your prayers!!

PJ, I also played the waiting game with the State and it really was frustrating. I am on Medicaid which I know is harder to get approved with than BadgerCare. With the comorbidities you have, I don't think you will have a problem with approval. They asked for more information on my request also. It is a generic computer field response which can mean anything from, "we need another copy of 'this or that' report," to "what is the PCP middle name?" I can't remember how many times I called them and, like you, got different answers with each person I talked to. I finally just talked to the wonderful lady in the business office at the clinic I am going to and she handles all of that. If you have submitted your surgery request at least 30 days ago, and your dr. has submitted the additional info they requested, it will be 2 weeks before you find out the decision. My suggestion is to not call down there anymore. It just frustrates you more and we don't need that stress. Try talking to the business office at your provider because they are the ones *****ceive the notifications/decisions from insurance companies. Mine let me know when my approval came in before she informed my surgeon and his staff! Keep us posted and I will keep you in my prayers too! Cindy

Cindy, Thank you for your kind words, you have encouraged me to keep on keeping on. I know thing will all work out for the best what every that may be. Your experience with the state insurer is promising and just the info I was looking for thank you again and good luck with your WLS venture. My sister had WLS a 1½ months ago and she has renewed faith in family and self. She is down 39 pounds and feeling great. I know most of my worries are self-inflicted but it is so hard to stay focused some times. Thank you again and I will keep everyone posted as I get new info. Pj Manning

Hi...My name is Lora, I am PJ's sister....Just wanted to let you know that he was APPROVED today!!! Thanks for the nice words of encouragement to him...I read your reply...We started this journey together back in March....we had hoped to do the surgery together...but with different insurance companies...Well you know how it goes...but all is well now! I am so happy for him!!!! Lora Lap RNY 5-26-04 -#40

pj keep fighting. i also have title 19 and was denied the first time. i sent them what they needed and was approved.

Judy, Thank you for your encouraging words. Your experience with Title 19 is very encouraging and I have renewed faith that they will do the right thing and approve my WLS. It is so hard to play the waiting game but it is good to know others in my position have been approved since the laws changed in 2002. I am thankfull for BadgerCare Title 19 because without them we would be uninsured, but I am so fustrated right now with the people answering the phone I could scream. I will just fill my days, nights, and thoughts with things other than WLS and Insurance untill I find out one way or the other. Then if I get denied again I will put on the proverbial boxing gloves and file the appeal. Thank you again and good luck with your WLS many prayers comming your way for a short recovery and a long happy life on the loosers bench. Pj Manning

My brother, pj was approved today!!!! send him some prayers! he is so excited....Thanks for the kind words to him! Lora, his sister... Lap RNY 5-26-04 -#40

Pj, congratulations! I heard that you were approved. I am so glad for you. Now you to can start on the road to a new and healthier life. My prayers are with you for a short recovery and better life. Fondly, Judy