Frustrated

[raec81 18]

I have KY Medicaid with my MCO being Anthem BCBS. I was required to do a 3 month diet as well as a few other things. The criteria they stated was 35+ and 1 or more comorbid OR 40+ with no co requirement. I fall into the second category. We completed all requirements and submitted the paperwork. They denied me! They stated a Medicaid change now requires all to have a co regardless of bmi which is not true. My doctors office contacted Medicaid directly to check on this and got confirmation nothing had changed. We are currently appealing. I'm so frustrated I could scream. Time seems to crawl by while I'm waiting.

Edited October 7, 2014 by raec81

[jessiquoi 623]

I hear your frustration. I'm currently waiting to hear if I got my insurance approval too, and I can only imagine how I would feel if I got denied. And to get denied by mistake, as it sounds like you were, would make me pull out my hair!

Hang in there, I've seen many cases of appeals being successful.

[Rovobay 920]

have faith.... I am sure you will get it all straightened out with your appeal!!! best of luck!

[raec81 18]

Thanks. I think venting helped some lol

[gabbykittyvsg 184]

Medicaid may have switched their policy to be the same as Medicare, which requires a comorbidity for any BMI Medicaid and Medicare are both under the same governing body.

[mamamia86 44]

Medicaid may have switched their policy to be the same as Medicare, which requires a comorbidity for any BMI Medicaid and Medicare are both under the same governing body.

I reallllly hope this is not the case. I have colorado medicaid, I don't know if this varies state to state? The last I heard here was a BMI of 35+ with a co morbidity or 40+ without a co morbidity. My Bmi is about 41 without any co morbidity but that's why I want surgery before I get any!!

[raec81 18]

It didn't change. My office contacted someone high up in the Medicaid office here and they said it didn't. Even though they denied my appeal due to administrative errors they said in the letter that I qualify but this this and this which were all administrative errors. How close are you to submitting to insurance? Good luck!

[mamamia86 44]

My surgeons office said they were submitting to medicaid tomorrow! I have a surgery date of December 9th, so I hope everything gets approved!