Michigan Medicaid denial

[Lsayles2591 0]

I am so frustrated I am in tears. I have been denied by medicaid for my procedure for not having an "uncontrolled, life threatening event". I am a Brest Cancer survivor and have issues with lymphodema and back pain from my surgeries. I have a hiatal hernia they were going to repair at the same time. It is documented that weight can increase the chance of cancer recurrence. How much more life threatening does it have to be? I have done all the prep and preliminary doctor visits and even had my surgery scheduled. Does anyone have any input or suggestions?

[Andi 78]

Speak with your hospital team. My surgeon mentioned that they have a lawyer that works with the hospital on denials.

[RebecaSparkles 247]

Get a lawyer, may be able to get a free 30 min session with a lawyer in your area who does healthcare law. Google it. Its part of keeping their license forced community service hours.

allons-y

[0tracy0 6]

Have you tried a peer to peer review?

[Lsayles2591 0]

Speak with your hospital team. My surgeon mentioned that they have a lawyer that works with the hospital on denials.

Who would your surgeon be and what hospital did use?

[Lsayles2591 0]

Have you tried a peer to peer review?

I'm not sure what you mean by peer to peer review?

[Lsayles2591 0]

Get a lawyer, may be able to get a free 30 min session with a lawyer in your area who does healthcare law. Google it. Its part of keeping their license forced community service hours.

allons-y

Thanks for the suggestion. I am going to check on this tomorrow.

[0tracy0 6]

A peer to peer review is when your surgeon talks with the medical director and tell them why the surgery would be medically necessary.

[Lsayles2591 0]

A peer to peer review is when your surgeon talks with the medical director and tell them why the surgery would be medically necessary.

Do you know of anyone that this worked for with Medicaid where their decision was reversed?

[Andi 78]

Who would your surgeon be and what hospital did use?

I went to Lahey Clinic in Burlington, MA. It's probably best to find out who's local to you (and if your hospital has someone that they know/trust)