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Thread: Denied

  1. #91
    Gastric Sleeve Member Kristi7928's Avatar
    I have had a gastric sleeve.
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    Kristi
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    09/27/2018
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    Dr. Bradley Thaemert
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    04-17-2022 02:53 PM
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    Default Re: Denied

    Still had not heard from the doc today regarding nausea meds so I sent another email. My stomach hurt so bad today that I didn't eat at all. Started at looking at side effects for both and my urine output is low even with lots of fluids, dark, I'm also drowsy, but sleep really good at night, and begged for something even OTC. Nurse forward the message to my doc and he replied with to stop both antibiotics and put me on Zofran. And to let them know how I'm feeling in the morning. Well, of course the Zofran was not at the pharmacy. Got some mashed potatoes down at supper and sipping a Sprite Zero at the moment. Will find out more in the morning what they are going to do regarding antibitotic treatment. I was worried about my kidneys - don't want to hurt them trying to save my feet. If it's not one thing it's another.

    On the plus side - all wounds measured smaller yesterday. Progress. I have been wearing these ugly edema stockings and my feet are so fat at the end of the day...and they are easy to go on. Asked the nurses about it and they said - well most of the people we deal with have way fatter feet and legs then you so we only keep that size on hand. The compression socks I got from amazon work way better. My feet are puffy in my eyes-to them not so much. Hopefully they get a smaller size in or I'll stick with the Amazon ones. I just don't think puffy feet are helping wounds. Would have been nice to know this 3 visits ago when you gave me the first pair.

    Haven't had time to call the Hearing Office - I'm alone in the office so of course everyone I have not heard from is calling with problems that are way over head. One guy called and said he got a new scooter from the VA, but it's too big and he's wondering if he can take it back. I'm like this isn't a pair of pants. This a machine fitted for you. I didn't tell him that, but I was thinking it.

    I also have a slight fear if I call it'll tick of the judge.
    HW: 245.4 SW: 243 CW: 160 GW: 135


  2. Gastric Sleeve Surgery With Weight Loss Agents
  3. #92
    Gastric Sleeve Member AnnieG's Avatar
    I have had a gastric sleeve.
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    Annie
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    10/05/2017
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    Dr. Ryan Heider
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    Default Re: Denied

    Quote Originally Posted by Kristi7928 View Post
    I sucked on mints and cinnamon candy today. It helped. I'm not much a tea drinker, but good to know for after surgery since soda is a no no and candy will be 99% of the time. I think my boss has some peppermint tea at work I can try. If not I'll get some.
    Hey lady bug. Sorry I've not been on line - had some health issues going on. You know my prayers are with you daily. I agree that denials are usually quicker than approvals, but so very worried about your antibiotic reaction. You have a tough row to hoe lately. Will email you! <3
    [I]HW: 240 lbs SW: 199 lbs GW: 140 lbs

    1 MO = 167.0 2 MO = 156.4 3 MO = 148.4 4 MO = 140.6
    5 M) = 136.0 6 MO = 130.0
    1 YR = 122.0 2 YR = 140.00 2.5 YR = 139
    Happy with my weight; happy with my size; over-the-moon with my health!

  4. #93
    Gastric Sleeve Member
    I have not had a gastric sleeve.
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    Dr. Felix
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    Default Re: Denied

    Did you get the Zofran filled? Were you supposed to continue the antibiotics after you got your Zofran? It's good that your wounds are shrinking at least.

    I can't imagine how stressful this waiting must be for you. I am not good at waiting, that would be the definition of hell for me.

    Do you like ginger ale? That is also supposed to help with an upset stomach. They also make diet ginger ale, I believe. You can also take Dramamine in a pinch, I've learned, as long as it doesn't interfere with your other prescriptions. Dramamine and/or Bonine. I learned that one time when I had a horrible flu.

    Hope you are feeling better and get some good news.


  5. #94
    Gastric Sleeve Member SAMom's Avatar
    I have had a gastric sleeve.
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    05/16/2018
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    Dr. Thomas
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    Default Re: Denied

    The doctor and hospital when I went takes Medicaid. I would come to Texas before I went to Mexico. Just my opinion tho.
    Good luck and God Bless you!



  6. #95
    Gastric Sleeve Member Kristi7928's Avatar
    I have had a gastric sleeve.
    Name
    Kristi
    Surgery date
    09/27/2018
    Surgeon
    Dr. Bradley Thaemert
    Join Date
    Sep 2017
    Last Activity
    04-17-2022 02:53 PM
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    Sioux Falls
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    Default Re: Denied

    Quote Originally Posted by donnahellno View Post
    Did you get the Zofran filled? Were you supposed to continue the antibiotics after you got your Zofran? It's good that your wounds are shrinking at least.

    I can't imagine how stressful this waiting must be for you. I am not good at waiting, that would be the definition of hell for me.

    Do you like ginger ale? That is also supposed to help with an upset stomach. They also make diet ginger ale, I believe. You can also take Dramamine in a pinch, I've learned, as long as it doesn't interfere with your other prescriptions. Dramamine and/or Bonine. I learned that one time when I had a horrible flu.

    Hope you are feeling better and get some good news.
    I did get the Zolfran filled, but did not go back on antibiotics. I see ID tomorrow along with podiatarty, but not my normal ID doc. We shall see what he says. Feeling a lot better. Stomach is still a little off, but getting better. I had a little bit of Diet Ginger Ale, but Diet Sprite seemed to work better.

    Refilled my normal muscle relaxer Amrix and insurance denied it and the pharmacy is trying to figure it out. I'm not too happy about it. I know why - because I got put on Baclofen (cheaper) they are probably going to make me try 3 more muscle relaxers just to get back to Amrix. Hoping pharmacy can convince them that it interacted with the Zyvox and it wasn't by choice I had to switch.

    I'm going to give it another week. I'm alone at work again and swamped and still need to tackle some other insurance issues with work and Cigna. Ugh.

    How are you Donna? Any news on your journey? How about your friend? After seeing myself on the news - good lord, that surgery can't come soon enough. Holy fat!! Ugh!
    HW: 245.4 SW: 243 CW: 160 GW: 135


  7. Gastric Sleeve Surgery With Weight Loss Agents
  8. #96
    Gastric Sleeve Member Kristi7928's Avatar
    I have had a gastric sleeve.
    Name
    Kristi
    Surgery date
    09/27/2018
    Surgeon
    Dr. Bradley Thaemert
    Join Date
    Sep 2017
    Last Activity
    04-17-2022 02:53 PM
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    Sioux Falls
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    Default Re: Denied

    Quote Originally Posted by SAMom View Post
    The doctor and hospital when I went takes Medicaid. I would come to Texas before I went to Mexico. Just my opinion tho.
    Good luck and God Bless you!
    Thank you. For the most part Medicaid has been very good to me. 2018 they decided to be crap. I think part of the reason is I had such good insurance through my dad. He was a mail carrier, and they covered me until I went full time in January of 2017. I was 36.

    Everything that could go wrong with insurance and Medicaid for this did. September will be a year! Hope I have it before then.

    I do <3 Texas - I'm a huge Cowboys fan and once I get skinny - I'm coming down for a game! I look forward to plane transfers being much, much, easier!
    HW: 245.4 SW: 243 CW: 160 GW: 135


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  10. #97
    Gastric Sleeve Member Kristi7928's Avatar
    I have had a gastric sleeve.
    Name
    Kristi
    Surgery date
    09/27/2018
    Surgeon
    Dr. Bradley Thaemert
    Join Date
    Sep 2017
    Last Activity
    04-17-2022 02:53 PM
    Location
    Sioux Falls
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    Default Re: Denied

    This is taken from the SD Medicaid site regarding hearings. I will still give them a call on Monday and see how long it takes.

    The ALJ will issue a written Pending Decision and deliver a copy to both parties. The
    decision shall at a minimum contain a statement of the legal issue, specific findings of
    fact, and specific conclusions of law. The parties have 10 days to mail written
    objections to specific findings of fact and conclusions of law. The ALJ will respond
    and issue a Final Decision. The ALJ’s decision is final and is not subject to
    Department review or approval.
    HW: 245.4 SW: 243 CW: 160 GW: 135


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  12. #98
    Gastric Sleeve Member DebbieD's Avatar
    I have had a gastric sleeve.
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    05/07/2013
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    Dr. Ramos-Kelly
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    Default Re: Denied

    Totally agree with the Mexico route. I bit scary but the BEST THING I EVER DID FOR MYSELF!



  13. #99
    Gastric Sleeve Member AnnieG's Avatar
    I have had a gastric sleeve.
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    Annie
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    10/05/2017
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    Dr. Ryan Heider
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    Default Re: Denied

    Good sleuthing, Kristi! You know you stay in my heart and prayers, and you've got so much going on! Take a fishing break this weekend!
    [I]HW: 240 lbs SW: 199 lbs GW: 140 lbs

    1 MO = 167.0 2 MO = 156.4 3 MO = 148.4 4 MO = 140.6
    5 M) = 136.0 6 MO = 130.0
    1 YR = 122.0 2 YR = 140.00 2.5 YR = 139
    Happy with my weight; happy with my size; over-the-moon with my health!

  14. #100
    Gastric Sleeve Member Kristi7928's Avatar
    I have had a gastric sleeve.
    Name
    Kristi
    Surgery date
    09/27/2018
    Surgeon
    Dr. Bradley Thaemert
    Join Date
    Sep 2017
    Last Activity
    04-17-2022 02:53 PM
    Location
    Sioux Falls
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    Default Re: Denied

    Another setback. Since I could not tolerate oral antibiotics they are starting me on IV daptomycin sometime this week. They are generally a 6 week course. That’s going to push me into August. I doubt they would operate while I’m on antibiotics. So many road blocks. I started the process in September.

    As much as I would like to just go to Mexico, it would not be cost saving for me. Maybe a little. IF I have to pay out of pocket Medicare A will pay for my hospital stay, anesthesia, etc. I just have to cover the surgeons fee which is $7300. And possible Medicare deductible. With my health issues I need to be close to my docs. Had I known all this drama would have happened over the last year I would have tried Mexico first.
    HW: 245.4 SW: 243 CW: 160 GW: 135


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  16. #101
    Gastric Sleeve Member Kristi7928's Avatar
    I have had a gastric sleeve.
    Name
    Kristi
    Surgery date
    09/27/2018
    Surgeon
    Dr. Bradley Thaemert
    Join Date
    Sep 2017
    Last Activity
    04-17-2022 02:53 PM
    Location
    Sioux Falls
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    Default Re: Denied

    IV's got started and everything worked out in my favor today to have my port changed at Avera. Not sure how or why, but that's easier for me and the staff knows my port. I've been going there for 18 years. Sanford I trust with my wounds.

    I'm on home IVs now and they only take 5 minutes. Minimal side effects and just do it after work. Pretty simple.

    Thought I was getting a call from Medicaid yesterday when I was getting admitted for the port needle. Got the message when I got home and it was the Governor's office stating the governor had appointment me to the Voc Rehab Board. It's the least I could do after they've done so much for me. I need to find out more and let my supervisor know. I was really hoping it was the hearing office.

    On Tuesday they wrapped me up like a mummy for my mild edema. By Thursday my feet were the size of Texas. They say they are fine and the profore is doing it's job. I went in Thursday to wound clinic as an emergency because my feet have never been so swollen ever! Well, I am pushing Crystal Light - helps me pee really well and adding some ACV to is - I'm sick of this swelling. Going to wrap some ACV/Water on towels on them tonight and sleep with them above my heart for the time being. I don't think this swelling can be good for my wounds so I will follow their instructions and document photos on my phone. I just want my tiny feet back.

    Have a great week y'all!
    HW: 245.4 SW: 243 CW: 160 GW: 135


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  18. #102
    Gastric Sleeve Member MBGray's Avatar
    Surgery date
    06/21/2018
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    Dr. Stephen Burpee
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    Default Re: Denied

    Yes, I had Cigna in the past and they definitely don't cover any surgical procedures for weight loss. As soon as my insurance changed to BCBS I went after it and only had to appeal once. I live close to Mexico and know a lot of people who go there for dental work. Don't give up, you'll find a way.



  19. #103
    Gastric Sleeve Member AnnieG's Avatar
    I have had a gastric sleeve.
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    Annie
    Surgery date
    10/05/2017
    Surgeon
    Dr. Ryan Heider
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    Oct 2017
    Last Activity
    11-29-2020 11:18 AM
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    NC
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    Default Re: Denied

    Congratulations on the board, Kristi! You'll do a fabulous job.

    Hoping the flooding has subsided, both on the roads and in your feet!
    [I]HW: 240 lbs SW: 199 lbs GW: 140 lbs

    1 MO = 167.0 2 MO = 156.4 3 MO = 148.4 4 MO = 140.6
    5 M) = 136.0 6 MO = 130.0
    1 YR = 122.0 2 YR = 140.00 2.5 YR = 139
    Happy with my weight; happy with my size; over-the-moon with my health!

  20. #104
    Gastric Sleeve Member
    I have had a gastric sleeve.
    Surgery date
    06/28/2018
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    Dr. Jefferson Vaughan
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    Oct 2017
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    Default Re: Denied

    I have Cigna and mine is covered-it's the plan that your company chooses or negotiates, which determines eligibility.


    1 month-219 lbs (-25)

  21. #105
    Gastric Sleeve Member Kristi7928's Avatar
    I have had a gastric sleeve.
    Name
    Kristi
    Surgery date
    09/27/2018
    Surgeon
    Dr. Bradley Thaemert
    Join Date
    Sep 2017
    Last Activity
    04-17-2022 02:53 PM
    Location
    Sioux Falls
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    173
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    Default Re: Denied

    Heard from the judge today. Denied.

    I had lidocaine injections in my shoulders today so since think my shoulders are a moot point I have current documentation.

    I’m emailing my surgeons nurse ASAP and having her resubmit. And expedite it.

    At this point I think a limb has to fall off before they consider it. If they deny me a second time I’m just paying for it.
    HW: 245.4 SW: 243 CW: 160 GW: 135


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