Denied

[sraebaer]

Many of us had no insurance at all, so if Medicaid works for you, consider yourself lucky.

I have insurance, It just has a strict no bariatric clause stuck in there. No fighting it for any reason, just no. I was self-pay in the states. Many here go to Mexico where it is much cheaper, but I was happy to pay more and be 5 minutes from home. (Or I should probably say I was blessed to be able to afford it.)

[Kristi7928]

Many of us had no insurance at all, so if Medicaid works for you, consider yourself lucky.

I have insurance, It just has a strict no bariatric clause stuck in there. No fighting it for any reason, just no. I was self-pay in the states. Many here go to Mexico where it is much cheaper, but I was happy to pay more and be 5 minutes from home. (Or I should probably say I was blessed to be able to afford it.)

Lucky? The reason I have Medicaid is because I was paralyzed at 15 from a rare virus. I got my degree and no one would hire me because I am disabled. I finally got a full time job with benefits when I was 37. Before that I was on SSI so I have NO savings. They have rules and regulations on how much money you can have. I have wounds on my feet that could lead to bilateral amputation. I could go on and on about the cost of paralysis. Lucky? Far from it. I'd gladly give up Medicaid to walk again.

[AnnieG]

Oh Kristi, your situation is singularly difficult. You've struggled very hard to accomplish so many things, and I know you are a fighter. You've done an astonishingly thorough job in getting all the paperwork together and filed to appeal and I am truly optimistic it will go through.

You rock, girl!

[sraebaer]

Lucky? The reason I have Medicaid is because I was paralyzed at 15 from a rare virus. I got my degree and no one would hire me because I am disabled. I finally got a full time job with benefits when I was 37. Before that I was on SSI so I have NO savings. They have rules and regulations on how much money you can have. I have wounds on my feet that could lead to bilateral amputation. I could go on and on about the cost of paralysis. Lucky? Far from it. I'd gladly give up Medicaid to walk again.

So sorry! I just meant people with bariatric insurance are lucky, I had no clue about your situation. I apologize. (Obviously I don't know the difference between Medicaid and Medicare.)

[scogra]

I was denied by my insurance as well. I'm 46, BMI at 45 so I want to do this to get my health back. My Dr. referred me to Mexico Bariatric Surgery and I am booked and scheduled for VSG on August 7, 2018. I have talked to a lot of people that have went there and I am excited to go! You can Google them as I can't post their website yet!

[Kristi7928]

The attorney for DSS called today and basically said I was going to lose and instead of waist everyone’s time to just do what Nikki says. He has a job to do. He did say that I fully believe you need the surgery, but you are going to lose. Said he’s never lost and I don’t meet all the qualifications. I need to find out if I’m going to keep getting denied if there is no scale for me to get on? And trying to convince these people my arms ARE weight bearing joints. My arms are my legs.

I felt bullied and uneasy. I left a message to see if I can post pone it. Still waiting for Nikki to either overturn the denial or grant my request for a peer to peer as my doc is ready. Also, left a message for Nikki to see where we are at for a peer to peer or a decision.

This weekend there is a disability expo and they will have attorneys that I am going to check out and get their opinion.

This whole thing is wearing me out.

[AnnieG]

The attorney for DSS called today and basically said I was going to lose and instead of waist everyone’s time to just do what Nikki says. He has a job to do. He did say that I fully believe you need the surgery, but you are going to lose. Said he’s never lost and I don’t meet all the qualifications. I need to find out if I’m going to keep getting denied if there is no scale for me to get on? And trying to convince these people my arms ARE weight bearing joints. My arms are my legs.

I felt bullied and uneasy. I left a message to see if I can post pone it. Still waiting for Nikki to either overturn the denial or grant my request for a peer to peer as my doc is ready. Also, left a message for Nikki to see where we are at for a peer to peer or a decision.

This weekend there is a disability expo and they will have attorneys that I am going to check out and get their opinion.

This whole thing is wearing me out.

Kristi, your situation would wear the paint off a plaster Saint as my grandma said. You know my take on this; you are a treasure of a person and I'm in your corner any way you need. You know my prayers are with you for a green light for surgery. Don't let the "SOBs" wear you down. You are a warrior girl! Love ya@

[Kristi7928]

Was able to postpone the hearing and looks like my surgeon’s nurse found me a scale. We will borrow it from oncology.

A little breathing room to hopefully over turn this or the peer to peer to over turn this.

[scogra]

Kristi, Sorry to read about your unfortunate but familiar post about being denied. As I mentioned prior, I had this happen to me as well but my doctor provided me with a "plan B" of going to Mexico. If you google "Mexico Bariatric Center" you will find the link for the website that I started everything through.

I'm curious of your situation and would like to share a way that I paid for mine and maybe you might have that option as well. Please PM me and I'll share how I have my total costs already paid! Keep fighting though and don't concede to not getting healthy!

[Kristi7928]

Kristi, Sorry to read about your unfortunate but familiar post about being denied. As I mentioned prior, I had this happen to me as well but my doctor provided me with a "plan B" of going to Mexico. If you google "Mexico Bariatric Center" you will find the link for the website that I started everything through.

I'm curious of your situation and would like to share a way that I paid for mine and maybe you might have that option as well. Please PM me and I'll share how I have my total costs already paid! Keep fighting though and don't concede to not getting healthy!

I sent you a PM a few days ago.

[Kristi7928]

Now they want medical records for the last year about my shoulder therapy. I don't know how to convince these people my arms are my legs. Lucky for me she can get my primary right away and I put in a online medical request for the physical therapy. I have years of PT treatment on my shoulders - bout ready to ask for it again. I got attachable motor before the new year and that's been in the shop more than it's been on my chair.

Still doesn't want to give me the peer to peer review. Said they go by medical records.

I am talking to a disability attorney tomorrow.

Exhausted. Emotionally and physically.

[Kristi7928]

Met with an attorney yesterday at the disability conference. I think I was the only person to utilize this wonderful tool at this event. Anyway - room full of lawyers and not a one is versed in Medicaid. It was a disability conference, 99% of these people are most likely on Medicaid. One guy stepped up to the plate, but basically was taking Medicaid's side. Know why - he works with the attorney going against me. Wonderful!

He said my biggest battle will probably be proving my arms/shoulders are weight bearing joints. Thanks to Annie's help I was able to pull up a few good articles and even though Nikki didn't want articles - these will probably get to her before my medical records, which thankfully I had PT on my shoulders for four months in the past year.

[Christie13]

Rooting for you Kristi. I am so sorry to hear you are getting the run around.

[DebbieD]

Going to Mexico (Dr. Kelly) was a godsend ! Someone asked me just yesterday why on gods green earth I went to Mexico? My insurance would not cover as well. $5000 vs. $20,000 easy decision only regret I didn't do it years sooner.

[simplyseahorse]

I am in the same boat - denied by United Healthcare. Will be figuring out appeal but also looking at Mexico options. I can't give up yet.