What Do They Want?

Well I had my first Appointment with my surgeon. I kind of knew what the out come was going to be. The doctor seemed more like I have a chance for an approval, but his nurse is the one who submits all of the paper work and she doesnt think I will get approved. They are sending me to my pc doctor to have him basically look for something that might help my chances. I had 3 back surgeries in a 10 month period. I am not going thru any more back surgeries. My weight is adding to my back pain tremendously. My pc doc wrote a letter stating this. I guess insurance dont care about your pain, they want something that is life threatening. Pain is'nt. I have lost control of my bladder quite a bit because of my back and weight problem, but that does'nt matter either. My family has a history of diabetes as well as heart problems. Is'nt it sad when you have to hope they find something so bad just to get some relief from the pain your in. I can not longer work because of the pain so I have a WI badgercare foward card (managed health care). Is thier anyone out there that knows what I could do next? Please I will listen to any suggestions. Anyone have the same type of problem or dealt with managed health care in WI? I am anxiously awaiting any reply. Thanks Linda

Dear Linda, I don't have Badger Care, but I do have the WI MA which is pretty much the same, I think. I had other health concerns when I applied so it was pretty easy for me to get the approval, but I think if you can document the diets you have tried, get a psychiatrist to say it is a good idea, and get you family doc to back you up, I think you will have a good chance. I can try to anwser questions if you have them. Just let me know. Good luck and take care! Hope

Hi Linda, I really don't have any answers for you, but I do know what you are going through. I still haven't had an appointment with the surgeon yet. I finally got tired of the PCP that I was going to & switched back to Dr. Sitorius in Janesville. He is the doctor that originally started me on Meridia 5 years ago. He is a really good PCP. I was seeing a Dr at the Family Health Associates in Beloit for about 3 months & the most time he spent in the room with me was about 5 mins. He ordered a Echo of my heart & when he went over the results with he me, he never even sat down. He walked in the room said, "your echo was fine it shows that the left ventrical is a little enlarged, but its nothing to worry about." & that was it, out the door he went. He also ordered a sleep study for me & never went over the results of that. After that I had enough. I got copies of the reports from the echo & the sleep study & took them to Dr. Sitorius on Tuesday 10/5. He explained in detail to me what the echo meant & put me on high blood pressure medicine. It stated right in the report that the enlargement was most likely due to hypertension. I explained to him that I wanted to have the surgery & when I got home on Wednesday the UW in Madison had called stating that my doctor contacted them. He also ordered some blood work to have my glucose & cholesterol checked. I feel the same way as you do. First I was told that I had to be 100 lbs over weight, then when I achieved that, they told me that I have to have a body mass of 40 or higher or other health realted issues. When I had the sleep study done & the echo, it was almost like I was hoping they found something wrong just so I could get the surgery approved. My question is if I'm 99 lbs over weight or my body mass is 39, that doesn't qualify me for the surgery, but if I gain 1 more pound or my body mass increases 1 then it's ok to give me the surgery. I know that they have to put some type of number on it, but when we are that close what's is the big deal. I know it isn't much but maybe knowing that others are feeling the same stress as you will help somehow. Dawn

Badger care has an avocacy service. They are the HMO Ombuds. They can work quite hard for you to get the HMO's to approve surgery. They are open M-F 8am-4:30pm. 1-800-760-0001. They have translators if necessary. Just ask for an Ombud and they will get to work for you. Good Luck to you and I hope this helps.