ATTENTION TENNCARE PHP

Hello all, I am in need of your help! TennCare Select had approved me for the DS on April 2nd; however NOW they are saying I cannot have the DS unless I am willing to pay the after care required ($3000). Also that if I take the RNY they will pay for it all, in full with a "in network" doctor. But as you know there is only one doctor in Tennessee who does the DS. I live in the west side of Tennessee with Medicaid that goes by TennCare Select...........but I if I lived on the east side I would have the same Medicaid called TennCare PHP. Did you know that depending on what county you live in you can even choose which one you want? I don't have that choice and so in lays the rub. I have appealed based on the fact that I am being discriminated against because of the location on my residence. The person who helped me file my appeal stated that there was a chance that all those who had the DS with TennCare PHP also had to pay their "aftercare". The insurance lady at the doctors office told me that is NOT true. The TennCare Lady also told me that I should go and "beg" my family, friends or church for the money. Nice Lady! Now this is where I need your help! If you have had or are going to have the DS and you are a patient of TennCare PHP please email me if you are willing to take 5 minutes of your time and 37 cents or willing to use a fax number. [email protected] I mean to have as many letter**** the TennCare Solution office as soon as possible in the next few days from patients who have had the surgery and had it paid thru TennCare PHP in full. I have a letter already done for you and will send as an attachment in Word. All you have to do is open it, fill in the blanks and feel free to change anything you like. It basically states my information, that you are writing on my behalf, that you had the surgery on such and such a date, or going to, that you have TennCare PHP and your approval and ID number and that the surgery did not or will not cost you any out of pocket monies, print it off and then either drop it in the mail or fax it off. If you do not have TennCare PHP but would like to help also, Please feel free to email me as well as. I would be most happy to ask you to write a letter to TennCare Solutions as to how well you are doing with your DS or revision and why you feel the DS is a better choice and how you feel about our divided state with TennCare. I have a fax number if you wish to fax something off or a snail mail address. TennCare PHP will pay without a hassle while TennCare Select gives us the run around about things that are just off the wall crazy. I say as a group we can make a difference; if we stick together they won't know what hit them. You will be helping me but know there are several others who are going through the same thing. I am fighting for myself and for all those who are waiting and being short changed too. I hope to be able to keep my April 2nd surgery date and won't cancel anything until I have no other choice. My appeal is on "fast track" so I am told I will hear something between 7-10 days. I am asking for anyone who is willing to help, to do it as quickly as possible. I thank you so much for your time in reading this and for your support whether it be in writing or in prayer. God Bless, Debra Dover, TN Pre-op April 2, 2004 Dr. Husted

What is the 3,000 "aftercare" covering?

Augusta, Hon, you are missing the point here. I have appealed this because it is without a doubt my being discrimination against based on where I live. One half of the state gets this surgery and it is paid in full while the other half does not......................What the money is for isn't the issue. But thank you for taking the time to read this. Debra

Thank you for all those of you who helped............... TennCare Select has approved me and surgery is set for April 2nd.

Sorry it took so long for me to respond but I wasn't discharged from the hospital until this past tuesday. However, I wasn't missing the point. TNcare select is not only for people on the west side of the state. My mother has TNcare select as well as my nephew and they both live with me in SE TN. TennCare Select is a specialty MCO within TNCare they don't let just anyone have it you have to meet different requirements for it than for the other MCO's. The reason I asked what the 3,000 was covering is that a lot of times the "fee" really has things that the ins co will cover that a Dr. just has to make a referal for. I don't know if this is the case with your Dr but a lot of Drs are having this extra "fee" to help make up the difference between what they feel they should be paid and what they contracted with the insurance company to pay for the procedure.