exceptional funding

[birchy]

Hi has anyone been refused funding twice by the pct. And had to apply for individual funding request for and exception case. I applied for funding after all hospital appointments ect. They told me to do a 6month weight-loss which i did. When i applied again for funding they said i didnt fit into the criteria anymore. Ive been fighting this for 25months has anyone been throught this or any advise please:cry:

 

[Roch]

I had exceptional funding and the only reason they agreed was my care needs would cost them more in the long run, also Sharon "dreamofbeingslim" she also had to go the exceptional funding panel twice and finally won her case and having her op very soon, maybe u could ask her for some tips how to go forward.
Hope u manage to get ur funding, from reading ur other posts is it Manchester u live in ,maybe if u post again asking anyone if they have dealt with ur particular pct that might help u.
Take care xx

 

[poo bear]

Hi
I was but my refused funding last year as i did not met the criteria they wanted. My GP wrote to the pct again who then came back and said i had to see a dietician for 6 months which i have just finished! I went back to my GP last week who has now writing to the panel again. Now i am waiting for them to get to me to see if i have been given funding or not! It really is a waiting game.
love Marie.

 

[dreamofbeingslim]

Hi yes I had to go through the exceptional cases route. I didn't meet the critieria and had to go to appeal twice and finally won when my gp sent new medical info. As I had recently developed high blood pressure and mild sleep apneoa and was becoming more immobile. She said she was worried about my general health. Hope this helps. It was a long fight first applied in December 08 and funding was granted in Jan 10.

 

[birchy]

thanks everyone for ur help roch how can i get to spk to sharon on er only im new on er and not sure what to do yet lol.xx

 

[Roch]

thanks everyone for ur help roch how can i get to spk to sharon on er only im new on er and not sure what to do yet lol.xx

U need to have 50 posts to send private message's, the best way to get ur 50 posts is to play the word association game and get ur 50 posts then the pm`s will automatically appear xx

 

[dreamofbeingslim]

Hi I am Sharron I posted above your last post to Roch. If you want to pm me I am happy to help. To get your posts up to 50 try playing the word games that will soon get them up there.

 

[birchy]

hi sharron thanks for the reply luv. My GP has applied for individual funding because of my depression and my knee because of my weight. Have u applied for this twice and got refused ur first time y did they refuse u first time if u dont mind me asking.And is ther any thing else that will help me wot u know of thank. xx

 

[dreamofbeingslim]

I applied once and got refused so went to appeal. Got turned down again as they said I wasn't an exceptional case (the problem is you have to prove you are an exception to anyone else in the same situation). Then we went to appeal again, got refused again and then I went on to develop high blood pressure and mild sleep apneoa. I had already been diagnosed with depression. My gp sent in the new medical info for them to consider and fortunately it was passed for funding. It was really difficult all the different refusals and it did get me down as it went on so long.`

 

[angie790]

God Sharron, what a huge carry on you've had! I'm surprised you didn't throw the towel in, I would have certainly felt like it. Do you mind me asking exactly what was/is the criteria for PCT funding in your area?

I find it really hard to understand how PCT's only see the short-term picture when patients are applying for WLS funding...ok, it costs them around £10,000 per op but it's a one-off payment, the cost of care for someone with obesity & associated co-morbidities can easily top that in 1-3 years...the exercise bloke I had to see said that is costs £10,000 per year to fund metformin for a type II diabetic patient...can't see what is so hard about doing the maths.

 

[12dobidog]

I was lucky as far as wls goes but the pct's seem to be more interested in other ailments, Getting diagnosed with sleep apneoa really helped my case. I'm not saying you should go this route but telling your doctor you can't sleep and going through the painless tests might help. Apparently 1 in 4 people that are obese have dsa so its worth a try
Good luck

 

[birchy]

hi angie manchester pct the criteria was 35-40 co-mobility ect and 40-50with 6month dieting. Now it 45 co-mobility

 

[dreamofbeingslim]

Angie my pct is bmi>40 with either diabetes 2 and or severe sleep apneoa.

 

[jewells1]

Hi I am new on here as well so not sure whether I am doing this right. I was refused funding and am awaiting the outcome from the exceptional circumstances appeal panel at my PCT. Not holding out much hope.

 

[janzz]

Hi Jewells, why are you not holding out much hope hun, have you any co mobilities, good luck on your journey, Jx

 

[angie790]

Angie my pct is bmi>40 with either diabetes 2 and or severe sleep apneoa.

Ahhhh, so I assume you didn't have either co-morbidity at the time of application, they binned you off....totally pants but at least you got it in the end xxd

 

[dreamofbeingslim]

Yes thank goodness.

 

[angie790]

Yes thank goodness.

It's bl**dy awful isn't it, that people like yourself (who live in an area with a cr*ppy PCT) are grateful to get 'more' ill, just so they will fund the op...so short-sighted, but I am pleased you got the funding eventually xxx

 

[dreamofbeingslim]

Thank you. That is exactly how I felt about it at the time and my doctor couldn't believe it either as under NICE guidelines I should have automatically qualified as had a bmi of over 60.

 

[angie790]

Thank you. That is exactly how I felt about it at the time and my doctor couldn't believe it either as under NICE guidelines I should have automatically qualified as had a bmi of over 60.

I'm confused, why on earth did they refuse so many times then, when like your Dr said, you should have automatically qualified without the sleep apneoa? B*stards