New here and need advice

Hello all, I am new to this site. To tell you a little about myself, I am on Wisconsin Badgercare, went through the six month supervised diet, counseling, and everything else I needed to supposedly get approved. I am 5'7'' and about 264 pounds and very frustrated. Yesterday I received my letter of denial from Badgercare. The Bariatric center said that if I did everything that they required than I wouldn't be denied. I suffer from headaches, backpain, depression, high cholesterol, and anxiety. I am twenty five years old and have been heavy my entire life. Please help! Can anyone give me any advice or share an experience with Wisconsin Badgercare, good or bad?? I would really appreciate your input. I just don't want to keep getting my hopes up if they will continue to deny me. Is it worth it to fight them?? Thanks in advance to all *****ply. Amanda

What was the reason you were denied? I know with my first insurance company I called them and asked what all the requirments were needed and they told me I needed to have X Y and Z So when my paperwork was submitted I was shocked that I was denied but the customer service reps dont always know all thats required. So ask for a copy of the denial letter it should say what you need to do to get approved. And if you fulfill all the requirements appeal because some companys always deny the first time. GOOD LUCK' Heather

Hi Heather, thanks for replying....I see your surgery is coming quickly....CONGRATULATIONS! You must be on cloud nine. As for the reasons behind my letter being denied--all the letter states is that it was denied because "services do not meet medicaid guidelines. The request does not meet one or more of the criteria found in WI Administration code 107.02(3)(e)" I did everything that I was suppose to do, but I did read that their new law is that you must have at least one comorbidity along with having a BMI of over 40. This was changed in Dec. 05. What kind of isurance did you have?? Do you have comorbitities as well? How long did the process take you?? Sorry for all the questions, I am just so anxious. Amanda

Hi Amanda My first insurance was unitedhealthcare and I was denied twice but my new insurance is bluecross blueshield CA and I was approved in less then 2 weeks. My comorbities are slightly high blood pressure and high cholesterol. Your high cholesterol sould count as a co-morbitity so you should really send an appeal letter if you need help getting one started you should ask your clinic if you could get copys of other paitents appeal letters so you could get ideas for your own. Dont feel bad about all the questions thats what the messageboards are for. I wish I could help you more, if you want to ask me anything else feel free to email me. GOOD LUCK Heather

Your surgeon should be able to tell you "exactly" why you were denied as can Badger Care. I fought w/those idiots for a long time!! Keep on fighting!!! Gala

Hi Amanda,\ Just curious as to how things are going. I am on Badgercare Comp Serve or Save it just changed from Atrium. I also went through the 6 month nutrition appointments and the psych evail and i got approved with in a week. i am sorry to hear that u r having problems with them.. keep me informed as how things r going.

I have not heard anything yet...The reason that they denied me was because my BMI was down to 39.9 after my supervised weight loss. This is no longer the case. I am above 40 again so my FNP has to dictate a letter to send back. Unfortunately she was gone last week, so she will hopefully do it tomorrow. I have been trying not to stress about it, but that really isn't possible. But anyway, congrats on getting approved! When is the big day??