In need of support

I have an appeal hearing in 2 days. I got a call from my lawyer asking if we wanted to withdraw from the hearing. He stated that my chances of winning an approval were really slim because I do not have diabetes or need joint replacement. 
I'm on State Medicaid....
My co-morbid conditions consist of;
-Obesity
-High blood pressure
-bad cholesterol
-High triglycerides
-degenerative joint and disk daises-Knees and lower back (just had an arthroscope)
-Impaired fasting glucose
-GERD- acid reflux
-sleep apnea
-stress inconsistencies (constipation, blood and pain when having a bowel movement)
-depression

Is there any one who can offer pointers on what to expect with the hearing or give me advice on what I can do to increase my chances of being approved.

Right now as it stands I'm trying to build a good argument around the facts that my health concerns are just being held at bay by the medications (I'm currently taking 8 types of medication some are narcotics). I'm at high risk with my BMI being at 44.3 (+or-) to develop type 2 diabetes or eventually joint replacement. I have had a back surgery but my back never improved.

Any help or encouragement would be greatly appreciated....

-Billie Jo

Sorry about your hardship.  I had a similar problem where my insurance company didn't want to pay for my surgery because I lacked the qualifications.  I don't understand some of these policies - they make it hard for people, like they're finding loopholes to get out of helping.  In the end, I asked a relative if they could lend me some money.  Good luck, I hope it works out for you.  And just remember, if there's will... there's a way!

Don't give up, if you feel this is the right thing to do for yourself.  I can only imagine that working with the state would be like, insurance companies are bad enough.

I was close to giving up this morning. Your right tho..! I feel this is the right thing to do and, I'm just going to do it. I'm a fighter till the end. I pray that the ALJ will take pity on me and, grant the approval I deserve.

If not I'll try again, my daughter has been very supportive of me and keeps telling me not to give up.

If anyone here in Washington State was approved through Medicaid with similar co-morbid conditions please respond. I think if I can show them that others were approved with similar conditions they might reconsider.  

And thank you all for the supportive responses...

-Billie

I know battling insurance has got to be tough. For some reason I thought that Medicaid approved peoplefor surgery easier than private insurance, but it doesn't look like that's the case. You have more than enough comorbidities to demonstrate medical necessity. I wish I had advice for you; all I can say is good luck, fight the good fight (because it is worth it!) and in the end you'll be so glad you stuck to your guns! Keep us posted on how things are going, ok?

Thank you all for the support. I got a call this morning from my lawyer he said DSHS called and wanted to postpone the hearing for a few more days. They need me to supply them with weight loss  documentation. I think that might be good news I'm kind getting super excited.

I'll be sure to give an update when I get more news.

thanks so much
-Billie

I am so sorry to hear of your struggles with DSHS... hopefully it is good new that  DSHS is asking for more documentation!!!

Helen

My daughter keeps reminding me to remain positive. I'm keeping my fingers crossed and hopping for the best.

Just a small update...
I got a message from my PcP's receptionist after missing my Doctors call. She wanted to know what Bariatrics program I was considering; Rockwood or U of W. I told her if Rockwood would except my insurance I would love to go there but, I have to make the trip to Seattle because of insurance coverage...

I'm thinking that might be good news...that's all I can think about today.

Thanks again for the encouraging words and support.

-Billie

Hi Billie,

I was trying to follow your thread (don't ask me why) and just want to say hang in there.

I have Medicare (different from Medicaid, yes), but went to U of W in Seattle for my first appointment in October 2009, the orientation with lots of other people. They seem to be real good there about knowing exactly what to do with different insurances, and they don't seem to have any attitudes about low income people or fixed income people. Medicare pays them about the same that Medicaid does.

I just had my lap band installed last Saturday 4-24-10....anyways, I know that Medicaid would have required 6 months of pre-surgical diet with nutritionist support...which I was glad I didn't have to do, but realized in the long run...the time frame worked out the same anyway...

Good luck on getting approved. I don't want to come off like a know it all, especially being new to the site here, but I have had WA DSHS in the past and was denied for braces for my son and for eating disorder treatment for my daughter....I did not get an attorney either time, but through good letter writing and quoting the WAC and RCW my son did get braces and my daughter got treatment. So....it can be done!!

Kristina in Everett

You fight it all the way to the end, you make sure you give your lawyer all your paperwork from your Dr's and make sure your Dr writes a statement as to why this surgery is necessary for your survival! Oh and make sure you bring copies yourself to court just in case your lawyer "loses" the documentation!

I wish you all the luck in the world!