refused

[bridiegeorge]

Please can somebody advise me... i have been refused surgery received my letter today and feel pretty fed up by all of this. my pct is north somerset and i was led to believe that a bmi above 40 would be enough to get the go ahead without my added health probs ie blood pressure sleep apnea(the letter states my sleep apnea is only mild) my bmi has been as high as 50 and is now 43 is it worth my while appealing or should i just accept that its not going to happen for me, any help would be appreciated. Bridie X

 

[Mazza]

Hi

Did they give any specific reasons for the refusal? I have checked the BOSPA website and the criteria for your PCT is:

NICE Guidelines criteria with priority given to patients with BMI over 35 with type 2 diabetes in age range 18-45.

You appear to fulfil this as the NICE guidelines are BMI of 40 with no co morbidities.

I think an appeal would be worth a try, I have no experience of the NHS system personally although my OH is going down the route but there are plenty of people on here who have appealed etc.

Good luck x

 

[Glenville]

Who made the application for you? Have you seen the application details? It is not unknown for applications to have the wrong information on them. If you don't know why the PCT have refused, ring and ask them. After finding all that out and if the details are correct, appeal.

 

[fatbutnot4eva]

I woudl say no dont give up, find out exactly why they have refused, If you have gone through your gp then go back to him or her and see what they say.
good luck x

 

[Cuppacocoa]

I too would find out more about why you were refused funding. I was also refused, twice. I was well above the required bmi for my area but suffered no co morbidities so I had to accept my only option was to have it done privately. The bonus was I only waited 7 weeks from my first appointment until my op!

Good luck with whatever you decide,
Cuppa xx

 

[dreamofbeingslim]

Hi definately appeal. I was refused went to appeal refused again and then went before the panel again with new medical info. I had since developed high blood pressure, sleep apneoa (mild) mobility going down hill and my gp is concerned for my general health. Luckily for me funding was granted last Thursday. This whole process has taken 13months so you might be in for quite a long wait but please keep fighting for it. Do you have cpap?

 

[Starsailor]

There are other routes your GP can take. Forgive me, as I don't know the technical terms! One is that your local NHS trust hold a pot of money for 'non urgent' ops i.e breast reductions, cosmetic surgery. Your GP can write to them and do it that way. Also, your GP can apply outside your local health authority evidently - mine told me that this week. And so they can go that route too, applying elsewhere.

 

[thinnerangela]

Definitely appeal - I was turned down the first time because there was no money so check whether thats the reason cos if so reapply at the end of March beg April at start of new financial year. I was funded in the new year!

I'd appeal anyway - you sound as though you should have been considered

And us Somerset girls should stick together - I've been exiled to Yorkshire!! ( married a Leeds man) - from Yeovil originally!!

Good luck

Angela xx

 

[Rache]

My doctor told me if mine was refused I could appeal via my MP?!?!? don't know any more than that, but it may be an option for you.xxx

 

[thinkbethin]

Appeal straight away and definitely find out the reasons for the refusal this time round. Please don't give up at the first hurdle. Good luck sweetheartxxx

 

[bridiegeorge]

Thanks, i will appeal this is what the letter said
reasons such as below can be stated here
* the case presented is not compliant with the NHS north somerset bariatric policy
* the patient does not have diabetes mellitus or severe sleep apnea
* the information supporting this request does not provide clear evidence that the health need in this case is exceptional in comparision with the health needs of other patients with the same condition who also do not have access to this treatment

it also states that this will be a dissapoint to me... they got that right. they go on to apologise and should my circumstances change or further relevant information become available i may of course re apply for review at a future date....
so i shall appeal and state my case but i suppose my need is not greater than others in my position, we all deserve to have it done, but as i saw on the news last night 240,000 want it and only 4300 had it done on nhs last year... looks i could be in for a long wait, or maybe i will eat all the pies and get as big as poss to get funding. i want to say i will carry on dieting on my own and it will all come off, but as i have been on and off diets since i was 17 i dont suppose that now at 48 miracles will suddenly happen. but of course i may win the lottery and be able to fund my own op. shall keep you informed with what happens next. cheers Bridie XX

 

[CHUCKY]

Hiya sorry to hear your news.
We live in Hampshire and i got finding my hubby who had bmi of 49 could get it because limit is 50. We contacted local mp and he just told us what we already knew total waste of time.
I do wish you luck but just wanted to warn you of problems out there.
Take care

x

 

[smilergem]

Hiya, I know how disappointed you feel, I have been turned down twice (I live in Cornwall), first time for funding, second time because they could not attach enough priority to my case (yes they also said we realise you may be disappointed with this decision). I had to wait another year, my GP referred me again last July, saw the consultant endocrinologist in September, had sleep test (no apnoea), and he put my case forward again. I am glad to say I now have funding (haven't received it in writing yet however), and there is now a six month waiting list to see the surgeon, then 4-5 months for surgery after that. It is a long journey I know, it has taken me four years to date. I hope you have some success with your appeal, there wasn't an appeals procedure for me to follow with my PCT. Wish you luck xxxx

 

[dreamofbeingslim]

Thanks, i will appeal this is what the letter said
reasons such as below can be stated here
* the case presented is not compliant with the NHS north somerset bariatric policy
* the patient does not have diabetes mellitus or severe sleep apnea
* the information supporting this request does not provide clear evidence that the health need in this case is exceptional in comparision with the health needs of other patients with the same condition who also do not have access to this treatment

it also states that this will be a dissapoint to me... they got that right. they go on to apologise and should my circumstances change or further relevant information become available i may of course re apply for review at a future date....
so i shall appeal and state my case but i suppose my need is not greater than others in my position, we all deserve to have it done, but as i saw on the news last night 240,000 want it and only 4300 had it done on nhs last year... looks i could be in for a long wait, or maybe i will eat all the pies and get as big as poss to get funding. i want to say i will carry on dieting on my own and it will all come off, but as i have been on and off diets since i was 17 i dont suppose that now at 48 miracles will suddenly happen. but of course i may win the lottery and be able to fund my own op. shall keep you informed with what happens next. cheers Bridie XX

Hi it sounds to me as though you are going for funding through the exceptional cases panel. This is the route I had to go as had no co-morbidities. I was the same as you I said to my gp how am I any different to anyone else in my circumstances. She wrote a brilliant appeal and it still got turned down. I then went on to find that I had mild sleep apneoa and high blood pressure and that coupled with my gp writing all this in a letter about new medical information along with saying she is extremely worried about my general health got my case passed last week. Please get your gp to write a letter of appeal. Have you had a sleep apneoa test? If not request one. If you get turned down again at appeal I was told you can then go further and have a one to one meeting (although you are allowed to take someone with you) with the chair of the panel. In this meeting alot of times things come to light that they have been unaware of so include everything (eg. mobility, everything about day to day life). Good luck, if I can be of any further help please ask.

 

[LisaG]

Don't give up! 40 is definitely high enough. Fight back and appeal.