Cancelled - *Pre-ops READ THIS*

"A little learning is a dangerous thing;
drink deep, or taste not the Pierian spring:
there shallow draughts intoxicate the brain,
and drinking largely sobers us again."

Alexander Pope, An essay on Criticism
English poet & satirist (1688 - 1744)

Because the doctor I was approved for and scheduled for did not request proper authorization, I had to cancel my thighplasty with my alternate doctor.  The first doctor cancelled *me*, because I insisted on asking questions, and I'm glad they did, because they lied and said they approved Medicare (primary) insurance when they did not.  I called and checked my AARP Medicare plan, alerted the doctor's office, they called and cancelled me the next day.

The second surgeon sang  the same tune as the first.  They do not pre-authorize Medicare prior to surgery, but bill afterwards. I had already received  prior authorization from Medicaid.
No prior authorization,  as most of us know, *guarantees denial from any insurance, public or private* and is a tactic used to strongarm patients out of cash who have it to pay, and weed out those of us who are less than middle-class or affluent.  I was middle class before lupus and fibro took over. Not anymore. My weight loss surgery helped bring  getting off disability within my grasp.  Medicare  is not welfare, but senior/disability health insurance that my tax dollars paid for when I was working.

I'm convinced that this tactic is used as a form of economic discrimination.  I did go to college, and had a very rewarding and well-paying career, until SLE and fibro took over,  so I don't fit what most doctors assume when profiling low-income patients:  that they are uneducated and maladapted to life in general.  It also doesn't help that I'm African-American.

That's right. Law enforcement is not the only profession  engaging in this horrendous activity.

First, I am on these government plans because of disability from lupus and fibromyalgia, not because I don't want to work.  I'm trying to get back to being productive.  The steroid treatment for lupus helped push my weight up to 405 at its highest.  I am now at 165, just five pounds away from my     PCP-imposed limit of 160 pounds pre-plastics, thanks to my DS, which was approved by and paid for with the same Medicare coverage I have now.  Just 20 pounds from my "chart weight" of 140.

My doctor estimated that 15 pounds of my remaining weight was skin and the uneven fat deposits clinging to it.

My surgery was reconstructive, not cosmetic.  I had been referred for thigh reduction after several bouts of cellulitis, which is an infection of the fat cells just under the skin.  The dermatologist that I was referred to determined that it was  being caused by abrasion from the compression garment I must wear to keep my lower body skin in place, enabling me to fit into clothes and walk.  Partly because my skin had been stretched out for so long, and partly due to genetics, it did not "snap back" after my massive weight loss.

Instead of empathy when I called to cancel, I got a chipper "OK, bye!" -CLICK-

I played by the rules.  I put forth the extra effort to personally retrieve and deliver medical records and make sure everything was in order. ****ep a set of every lab and procedure related to my weight loss surgery, and I even have a copy of my surgical report from my DS)  My Medicaid prior authorization expires June 23rd, and there simply wasn't enough time for me to do another consult and find someone who would do the prior authorization correctly.  I have Medicaid because of disability.

This was a year and a half in the making.  I went to four consults after I'd lost the majority of my weight. Only one surgeon said he would not do the surgery. 

Perhaps if I had not exercised due diligence, and just played dumb, I would be having my surgery, recuperated  during the summer and be on my way back to school in the fall.

I was seeing light at the end of the tunnel.  Now all I can see is darkness once again.

Lesson:  DUMMY UP WHEN NECESSARY!

While I am truly sorry for your difficulties you lost all credibility with this:

It also doesn't help that I'm African-American.

That's right. Law enforcement is not the only profession  engaging in this horrendous activity.

Just how big is that chip on your shoulder?

Jules-

It's not a chip, it's a life experience.

I have lived as both middle class and upwardly mobile,  and currrently low income, barely scraping by, and was simply relaying my own experiences. The health care treatment one  gets as a member of the middle or affluent classes is most assuredly different.  Members of the underclass, of which I am now one get inadequate or no care, middle class or affluent people get the best care. However, where I live, Caucasian low-income clients  get better treatment at the local Family Resources Agency.  (what they used to call the welfare office).

When I worked, before lupus and fibro made my career physically impossible and I had either an HMO, PPO or traditional insurance I had a choice then, there was no question  about whether I got the treatment I needed or not.  I got top of the line health care.  I worked for a large corporation that was self-insured, and was among the last to offer traditional pensions as a benefit. I was laid-off prior to the company's shutdown just 5 month short of vesting.  I had survived four prior layoffs.  
Because our company was also part of a television station, plastic surgery was a covered benefit. I lived in a nice condo, right on the shore of Lake Michigan in Chicago, wore well made clothes purchased at retail, and ate fresh food from a clean, well lit supermarket as opposed to a dirty corner store that often would sell rancid meat to neighborhood residents who didn't have the transportation to go anywhere else.  I saw these things because I was a reporter, but like many others in this country, I could go home from that environment at the end of the day.

Now I live in a basement apartment in a complex that is one step up from low-income housing projects, and rent is not subsidized.  I still wear well made clothing, only now it comes from Goodwill and St. Vincent De Paul, which is actually great, because I'm into my 5th wardrobing, and since I know what to look for, I can get clothes just like I had before, only smaller, and for a fraction of the cost on 50% off days.  It's called clothes recycling.  I got rid of my too-large clothing at a consignment shop, and spent the money earned on clothing I needed,  gas for my car and more nutritious food in line with my DS eating plan.  

I saw my first homeless person when I had my first job after graduation in Washington DC in the  1980's. The de-institutionalization of mental health facilities in the shift toward community-based mental health care was at its height.  The trend now is prison-based mental health treatment, in what I believe is the return of mental health institutions. In fact, when I studied sociology as an undergrad, at one point in history, the mentally ill  and poor were housed in prisons.
(this was actuallly addressed in my Psychology textbook, and on a PBS Frontline program.  I also just recently read this in our local paper.)

Sometimes, I supplement my groceries with community food pantry items but I always go for as much protein as I can get.  Most times, only one meat is allowed, but I have made arrangements, thanks to a letter from my PCP to be able to get an extra dozen eggs,  extra yogurt and cottage cheese and extra milk, which I freeze in Rubbermaid refrigerator bottles.  When it;s on special at the store at 2  gallons for $5.00, I do the same thing. 

In the medical community, if you hand the receptionist Medicare and Medicaid insurance cards, right away, their attitude toward you changes.  You are patronized, and talked down to as if you are illiterate. It is assumed that you are on welfare, and I make it perfectly clear that I am on disability.  It also doesn't help that lupus and fibromyalgia are what are known as "invisible disabilities".  When I was riding around on my personal mobility scooter  at 405 pounds, there was no question that I  had a disability.  I can't help that African-Americans in this country and  my situation are automatically perceived (profiled) as not wanting to work and live off "the system", which if I'm not mistaken, you made a comment on a distant post from me that "she's on disability and knows how to work the system."  That implies to me that you or whoever made the comment believe I'm  doing something dishonest, even though I worked as a professional for many years and paid taxes into "the system" that I'm allegedly "working".  

I have heard people say out loud that they hate President Obama because a black man has no business in the White House. 
I'm telling you my experience from both sides of the fence.  
There are more bariatric patients that have fallen on hard times than you can imagine, andin fact, I'm working with my church  and community groups to provide bariatric nutritional supplies. 
I'm just stating that being in a tough place has taught me that economic discrimination does exist, and that people of color bear the brunt of it. Since I see you are from Georgia, I have to add that when I worked in Mississippi, I saw less racial strife there than I see today in my Northern community.

It's my opinion and experience, and I'm sticking to it.
You can't call it a chip unless you've lived it, and I'm trying my best to overcome my present cir****tances.

Jules-

Most assume that if you are African-American and recieving *any* form of public aid, you are uneducated and lazy, especially when you have an invisible disability as I do.

It does not only happen to African Americans.  I too played by the rules.  I went to college at age 30, earned a mathematics degree and taught school.  After 10 years of teaching, my retinal disease forced me into disability retirement. 

I worked in industry for many years before I went into teaching.  In the state I live in teachers do not pay into social security...I did though because I did not begin teaching until I was 40.  Anyway the year I retired, my state passed legislation BARRING ME FRO RECEIVING SPOUSAL SOCIAL SECURITY IN THE EVEN MY HUSBAND PRECEEDS ME IN DEATH. 

What does that mean...it means if my husband dies, I do not qualify for his SSecurity because I receive teacher retirement. They consider it 2 state pensions.   REALLY????  All other state workers will receive state retirement and social security.  My husband is 63, will wor****il probably 70, has paid into the system, but I will not receive his benefits upon death.   My retirement is $750  per month of with I PAY $650 FOR MY HEALTH INSURANCE. I get $98 per month...THAT IS ALL.  Try planning on living on $98 per month.  I bet you get more than I do.  I also do not qualify for social security disability because my credit are more than 10 years old at the time of m y disability retirement.

So the rug was pulled out from under me too.  That is a fact.  The teachers' unions fought passage of that law for years...but lost.  I worry each and every day about what the heck I will do if my husband passes and we do not have enough money saved to last me for the rest of my life.  This crap happens to everyone, regardless of color.

Your state has a problem, big time!
You are disabled by a health condition, and Social Security Disability is a Federal benefit.

I'm not saying that Caucasians/European ancestry individuals do not experience discrimination.  I'm just saying that non-Caucasians, especially African-Americans and Latino-Americans bear the brunt of the instant assumptons made because most of us cannot hide our ethnicity. 

Back when my parents were young ( my Mom died April 18th at the age of 92.  She would have been 93 April 22nd, the day before her funeral.  Dad died 20 years ago) "passing" for white was a survival skill that many who could *did* use to escape racism and hae better economic opportunities.  Only when it became "fashionable" to be "black and proud" did they "come out" much like the LGBT community does today.  NO I am hetero.  I'm just trying to give some historical perspective.

As we all know, from being morbidly obese, fat discrimination is the last "safe" area of bias. Only two states have laws on the books outlawing discrimination due to size.  We were ridiculed, and for many who had no co-morbidities, that was enough for weight loss surgery.

As for my SSDI, (SSI is for those who have never worked and is based solely on financial need), I probably do get more.  However, that is a penalty in and of itself in my state.  Because I had a good job, and found myself disabled, which I never thought would happen, I am penalized, in that i don't qualify for much other than Medicare and Medicaid health insurance.  No Food Stamps here!  No  transporation for long-distance medical visits. Everything comes out of my check, and even co-pays for some of my lupus medications are a struggle with paying rent, food, etc.  My DS was done to resolve health issues, which unwittingly gave me a whole new set of health concerns in the form of cellulitis from the friction of my compression garment.

That's why I need the thigh skin removed.

By the way, I have a  $1,036.00 "spend down", which is what I have to spend each month out of pocket before Medicaid picks up anything, even the cost of an aspirin in the hospital. I will have to pay at least that out of pocket, and probably more. 

You are right about my state....I love it, but they screwed up here.  Teachers represent a very large number of state employees thus a lot of saved money.  That year 13 other states enacted the same legislation.  Social Security denied show I don't quality  because my credits earned under the system were more than 10 years old by the time I became disables.  I had an administrator tell me every year to work at Walmart during the summer months so my credits would be current. I taught summer school instead.   He knew what he was talking about. Oh how I wish I had listened to him.  I should be entitled to my husband's social security, but not any more.

There has to be a medical school or program that accepts your insurance.  Go to the Texas Board,  There is a list of medicare/medicaid doctors, by state, I believe.  If it does not copy, go to the Texas Board.

I've attached the link.  I did not go through it, but could you go out of state if another doctor accepted your insurance?  Here is the link.

http://www.obesityhelp.com/forums/TX/3462534/MEDICAID-AND-ME DICARE-SURGEONS-LIST/

Noto and have the surgery totally paid for.  I live in Indiana.

Indiana medicAID has given prior authorization.  Medicaid does not travel across state lines. I would have to move to another state and reside there, be enrolled in that state's medicaid program, and have prior authorization approved by them, etc.

I have a Medicare Complete plan with prescription and dental through AARP.  It is the plan in question.  The doctors either don't take any insurance, or at least the two I settled on, refuse to obtain prior authorization because they want cash-paying patients.  As I said in my original post, any health insurance, public or private, requires prior authorization for *ANY* surgery.
Doctors and their insurance and billing clerks know this, so they have found a way to deny treatment to the economically disadvantaged. 

In my case, a medically necessary surgery to correct my malignant morbid obesity, left me with a deformity that is also impacting my health, and has been deemed medically necessary by my state's medical review board, no appeals necessary. I will have to pay some out of pocket, as I'm on a Medicaid "spend down" of $1,036.00 before they will pay any medical expenses of any kind.  This is a monthly spend down.
 
Doctors will not correct the deformity  due to my economic status, and my age.  If I were in my 20's or even 30's, I beleive I would be treated for this. 

I'm calling Legal Aid on Monday.

You need to find a surgeon who will accept your insurance and get the prior pre authorization necessary.  The one I am choosing to use dose not accept insurance....I had a consultation with one who does accept insurance. 

I do not know anything about Medicaid or Medicare...I pay for private insurance.

If you do not have enough work credits, then you can apply for SSI. SSI does not depend on work credits. For SSI, you income and assets must be less than $2,000.