Today was my appeal hearing

I went in feeling pretty good and came out feeling defeated again...I had just found out last week that the reason that I hadn't been able to walk for the past three years was because I had a fracture in my ankle that no one ever found. The bone had chipped off of my ankle and was attached to a ligament inside. Some days it will be pressing against something and I can't get out of bed and other days I am limping around. After 3 years they found it. My foot surgeon says she won't operate with my weight this high because it won't heal. I took that information into the appeal hearing and felt pretty good and he informend me that that wasn't a life threatening condition...And all but said no to the surgery again. I will hear my answer within 90 days. i explained how bad life was and that they are paying out food stamps and medical to me because I can't work and it amounts to more for one year than the surgery costs...And that things are only going to get worse.. Just because I don't have diabetes or high blood pressure they won't even consider me....Thanks for listening I just needed someone to vent to... I told them at the hearing that I am not going to give up and I will request an administrative hearing...I just hate having to sit here and wait...I know you understand because I have read some of your profiles and you have also waited years.

I feel for you. The day you posted on the board that you'd been denied by Medicaid was the same day that I recieved my denial from them. I was mad, but not because my hopes of surgery were lost, because I still had other avenues. What depressed my the most was that I knew that there were others,like yourself, that needed this surgery, and this was their only option. It is almost as if Medicaid places no value on improving the lives of those on the program. What really gets me is this--I have high blood pressure, sleep apnea, pre-diabetes, heel spurs on both feet, degenerative arthritis in my lower vertebrae and ankles, and a family history of stroke,my bmi is 53, and when I submitted for approval, I showed two consecutive years of medically assisted weight loss, and I was still denied. What more did they want? I wish you the best, and I hope that you can find a way to get the surgery you need.

I started this journey in 1999 I finally got the surgery. I stopped trying (that you cannot do.) Never give up. To be honest this surgery is really turning into a very successful surgery. They have got most of the kinks out of it. I think when the insurance companys do their math they will see how much they are saving. I know they are already saving from me. I think things are going to turn around. I hope so. My youngest daughter needs this surgery as well ( she is 26). Since she has been young she had a weight problem. Now she has gained all her weight back and plus some since she has been in recovery. She had alot of problems with weight I think that had alot to do with her addiction. But she has learned to love herself big. and she does. Just keep bugging them. Be the fly that doesnt go away. Hugs my way Barb

I too will be going through OH Medicaid. Reading your post discourages me some but I guess it is preparing me for what may come. I will do what ever it takes to get this surgery. If I have to stand on my head I will

Keep believing that this will happen for you. When you go into your hearing leave all the medical papers behind. Bring friends and loved ones and have them read letters telling the reasons that you should have the surgery. Ask everyone who loves you and knows how you struggle to write letters and you are entitled to have those persons present at your hearing. Allow them to read those letters to the judge. Make a plea to the hearing officer about all the medical bills that are going to continue to add up due to obesity related illness and medications. My pharmacy printed up and itemized list of all the medications that I had been on since the day of my initial application for surgery. How many thousands and thousands of dollars my prescriptions had cost the state. If you have had Drs visits and Hospitalizations ask for itemized bills from each provider and hospital. Add on bills for tests, etc. I took all this the day of my final hearing and the judge was impressed with how much all this was costing. I had the cost of the surgery on paper and showed them that too. The final thing I truly feel sealed my final approval was a letter written and read by my 12 year old son on how he had seen me suffer and that he didnt think he was going to have a mother much longer if I didnt get the surgery. I found all the medical records in the world didnt mean as much as that emotional plea by my son. I pray that some of these ideas might help you. Yes these things are time consuming but as we know the state is hurting financially and if they can see how much $$$$ they are putting out on you to keep you going in your current condition and how much more you will cost in the future as you get older and unhealthier. If you have any questions feel free to contact me. I might be a little slow in getting back to you , but I will do my best. I am working full time and babysitting my little grandbaby. These are all things I couldnt of done 7 months ago. If you need someone ( like me ) to write you a letter of how this surgery has changed my life I would be happy to. They have to allow these letters or speakers as evidence in your appeal. I will keep you and all the many many others awaiting approval in my prayers. I thank God each and every day I had the patience to out wait Ohio Medicaid and get my approval after 2 1/2 years. BIG HUGS.. ANd Please Never give up faith that it will happen for you.. God works miracles and can touch the heart of your hearing officer. Dont be afraid to show your true emotional state that day. Let them know just how very much your life depends on you getting this life changing procedure. The Best of luck to you Laura

Hi Debbie, I just went into my aol mail and read yours. Then popped in here to drop a post and seen your post. Anyways I do apologize for not writing back - I really need to check my mail more often I am so sorry to hear about your ankle, but also happy they found out what is and has been wrong with it. This sucks that Medicaid doesn't feel it's life or death though. They just do not realize it truly is, the longer you stay idle, the more weight you put on, then your blood pressure will get whacked.. Oh yeah they don't really care about us nor preventive medical practices unless "we" are children. I HATE HATE HATE this about our insurance. Well I don't know of any insurances co's that actually do care. Speaking of.. yanno the reason I am on disability? for any treatment I need approval, which can take up to a year to get, now if I was on 1 of the sub insurance's such as Paramount, it would only take 2-3 days. However if I switch, then my disability can be revoked. Splain that 1. Anyways this is not about me. DO YOU HAVE THE OPTION TO CHANGE your insurer Debbie? This is an option to consider, their guidelines are more set in stone than straight Medicaids and give answers a lot sooner. I will continue to pray for you to get the best possible outcome from all of this. Yep waited for years.. 5 of them before my road headed in the right direction. Hugs, hang in there lady, Vickie