DENIED AGAIN!!!!!!!!

Ok, so I have been denied again for surgery...3 time since January! I have Medicaid (Badgercare). They changed the criteria on Dec 13, 2005. I missed the date by 8 days! The hospital had submitted 2 times and was denied both time. I appealed and have just received yet another denial. I am appealing for the second time. This is what I have so far for the 2nd appeal letter. What do you think?? Any changes or additions? April 17, 2006 Division of Hearings and Appeals P.O. Box 7875 Madison, WI 53707-7875 RE: Request for new hearing for Kimberly E. Whitford Dear Sir or Madam, I am requesting a new hearing on the basis of submission for authorization was sent in only 8 days after the criteria changed. I had completed all required criteria prior to this change. I feel that there must be some sort of grace period for this type of situation. If I had been informed of this criteria change at an earlier date or found the information at the www.medicaid.com I would not have persuaded any further. I was only informed of the official date of the criteria change in a March 13, 2006 letter from Division of Health and Financing. I do have several pieces of information from the website and other sources, nothing indicates an exact date and some of it is not available until January 2006. This information was not sent in for the 1st hearing or any of my other documentation. I had contacted Administrative Law Judge Kenneth P. Adler prior to the 1st hearing and was directed not to send any information. I don't feel that is ethical for such a life changing decision to be made by a 15 minute phone conversation. I am more than just a name on a piece of paper. I am a mother, a daughter, a cousin, a niece, a friend. I have dreams and goals for myself. I work full time as a daycare provider. I feel that I am just as entitled to have insurance cover this surgery under the current cir****tances, just as it would for someone who had there information submitted on December 12th 2005. Please do take my situation and cir****tances into consideration for this very important and life changing decision. I have never wanted anything as much as this surgery. I have never put up such a fight for anything in my life. I want to have this surgery more than anything in the world! So what do you think? Also, what are some good self pay insurance plans that cover gastic bypass or lap. Just incase I have to go that route! Kimmie

Kimmie, I know it is frustrating to keep getting denied, 3 times I cannot imagine. I live in MN and have Blue Plus which means I am on State and I was denied once and then wrote a letter and I was approved. In my letter I wrote about the problems my weight has caused, such as high blood pressure and high cholestoral. I also stated about how how high chlorestoral contributed to my fathers young age at death. I do not know if this helps and I know MN is different than WI but I wish you luck and hope things work out for you. Angel

Keep trying. I had to go back 5 times. I am forturnate to have great health benefits where I am employed but I had to fight from April 2004 till September 2004. Just letting you know that your fight is not in vein. Funny thing is that I was approved first time around for my breast reduction that I am recovering from now. There is a reason for the fight, sometimes I think it means more if we have to work/fight for it. Take Care, Tammy