has anyone gotten out of this by your MD writing a letter to the insurance company....basically stating that you've been under his/her care for years...

Thanks for your input!

has anyone gotten out of this by your MD writing a letter to the insurance company....basically stating that you've been under his/her care for years...

Thanks for your input!

I don't know what insurance you have, but Cigna will not let you get out of their 6 month supervised diet at all.

Peace Out!

T~:hippie:

I got out of the 12 month requirement. I have no idea how but my obgyn wrote a letter stating that he had been seeing me for 13 years and the I have had battled my weight that entire time. While I was going through the process of submitting it to my insurance and getting all my tests I created 9 months of visits that my dr was willing to sign off on and if push came to shove I would have waited until I got 12 months worth. It didnt. I was approved 1st time through. I started from my last yearly physical and had seen him a few times for some other issues and we filled in the other months and he signed them. Good Luck.

My PCP submit a letter stating that she is aware of my weight loss attempts.. I also sent in emails to and from my PCP regarding weight loss, going to the gym and lab requests as well as my gym billing records from 8/05 to present.. IT took BCBS about a week and a half but I was approved.

Sweet...I have all that junk submitted...Curves, the Gym, WW, other attempts...bleh!

I'm hoping for the best....these next few weeks will be the determining factor I guess!

Best of luck to you!

I wish you luck, but for some insurances that is not good enough. You need to get your hands on a copy of your insurance policy's requirements for approval. My company's says:

Documentation of a coordinated, physician-supervised weight loss program for a minumum of 12 months, started and completed within a 24-month period prior to the reccommendation for surgery. (The documentation requirement may be satisfied by a detailed submission about your multidisciplinary weight loss program or by your PCP's medical records. PCP documentation must indicate a minimum of 10 visits during a one-year period and verification of the minumum required weight loss.) The documentation should include periodic weigh-ins (at least monthly), dietary therapy, physical exercise, behavioral therapy and/or counseling and, if applicable, pharmacotherapy.

By multidisciplinary they mean a weight loss program run by a physician and involving a nutritionist, exercise physiologist, etc. Yep, I had to do 12 months and I hadn't made my required weight loss in those 12 months, so I had to keep going until I lost what I needed to. For my insurance Curves or WW or Jenny Craig would not suffice. They will not take a letter from the PCP, either. It MUST be copies of office visit notes and those notes have to include weights and discussions of what I was doing to try to lose weight (exercise, changes in diet, etc.)

I hope that your insurance is easier than mine, but if I were you while I was waiting to hear, I'd make sure to visit my doctor and discuss what I've been doing to lose weight and get the diet history started. It can't hurt!

I got out of the 12 month requirement. I have no idea how but my obgyn wrote a letter stating that he had been seeing me for 13 years and the I have had battled my weight that entire time. While I was going through the process of submitting it to my insurance and getting all my tests I created 9 months of visits that my dr was willing to sign off on and if push came to shove I would have waited until I got 12 months worth. It didnt. I was approved 1st time through. I started from my last yearly physical and had seen him a few times for some other issues and we filled in the other months and he signed them. Good Luck.

Insurance Fraud

Actually nothing was ever turned in so its kind of hard to be insurance fraud. Thanks though. My OBs initial letter stating my long term struggle with obesity and my surgeons medical necessity letter were enough information for it to be approved.

Actually nothing was ever turned in so its kind of hard to be insurance fraud. Thanks though. My OBs initial letter stating my long term struggle with obesity and my surgeons medical necessity letter were enough information for it to be approved.

Surprising to me that a physician would be willing to falsify medical records. Its against the law.... Especially knowing it may be turned in to insurance company... Not very smart.

The forms were never requested, that was my point. Eventhough my insurance stated that 12 months were needed I was approved without anything besides a letter from my surgeon. I fully expected to have to wait until I had 12 months worth of actual visits. These weren't medical records actually. They had no letterhead. They were notes typed by me stating what exercise and food plan I had used and what I weighed those months. There was nothing false about them. No records in my file were created. There was a thread started on this website back about 8 months ago from a gal that had done this and I thought I would try it. Ended up I didnt need any of them. Apparently sometimes companies that need 12 months will accept 6 months or 9 months worth. I was guessing I would have to provide acutal medical reconds, in which case I would have had to wait until we could do that, but while I was waiting I was seeing him every month so I would have 12 months of actual vistits with him.

Quote:

Originally Posted by nursekathy2u

Surprising to me that a physician would be willing to falsify medical records. Its against the law.... Especially knowing it may be turned in to insurance company... Not very smart.

I'm not quite sure why you care? Isn't it just wonderful that the poster *did* get approved and is going to be able to have this fantastic tool!

And I don't see how it is insurance fraud if a) nothing was ever submitted that was created and the poster DID have weight problems for YEARS, there just wasn't the dotted "i" and the crossed "t" the insurance company makes you have in order to try to deny you.

After receiving what my insurace company required, my physician and I went back through my records (I *did* go monthly, and we *did* discuss my weight every month, but sometimes it didn't get written) and added things to each month's note like "patient is eating more veggies" or "patient is walking 30 mins a day." I do not consider that fraud, it is adding late entries to records.

Quote:

Originally Posted by nursekathy2u

Surprising to me that a physician would be willing to falsify medical records. Its against the law.... Especially knowing it may be turned in to insurance company... Not very smart.

I'm not quite sure why you care? Isn't it just wonderful that the poster *did* get approved and is going to be able to have this fantastic tool!

And I don't see how it is insurance fraud if a) nothing was ever submitted that was created and the poster DID have weight problems for YEARS, there just wasn't the dotted "i" and the crossed "t" the

Insurance company makes you have in order to try to deny you.

After receiving what my insurace company required, my physician and I went back through my records (I *did* go monthly, and we *did* discuss my weight every month, but sometimes it didn't get written) and added things to each month's note like "patient is eating more veggies" or "patient is walking 30 mins a day." I do not consider that fraud, it is adding late entries to records.

Thanks Faith! I should have known that someone would take issue with me but my point was only, submit what you have and go from there. My insurance company states those same requirements but didn't actually ask for them. Maybe my drs statements that I had been battling obesity for the 13 years he has known me, that we had run thyroid tests, that he had prescribed phen fen when it was out that I had been on every diet in the land to limited avail was enough to get approval. I have no idea why I was approved without it but I was and I count my blessings everyday that I was able to get my surgery paid for. Its the best thing that ever happened to me and I wish everyone could get their insurance companies to pay for it. God knows most of us pay enough in premiums to feed a small village in a foreign country!

Quote:

I do not consider that fraud, it is adding late entries to records.

Sorry faith...it is fraudulent BIG TIME!! see quote from

http://www.thedoctors.com/pdf/riskmanagement/J3223.pdf

Never add anything unless you write a separately

dated and signed note. The patient, a third-party

payer, or a plaintiff’s attorney may have obtained

a copy of the patient’s original records. The entry

date for ink or type can be accurately determined

retrospectively, and any alteration after the fact

will seriously compromise the defense of your case.

I guess I am confused? what was added? Nothing went into any file anywhere. This is taking on a life of its own.

Not in your case, Renee, in mine.

Never

add anything unless you write a separately

dated and signed note. The patient, a third-party

payer, or a plaintiff’s attorney may have obtained

a copy of the patient’s original records. The entry

date for ink or type can be accurately determined

retrospectively, and any alteration after the fact

will seriously compromise the defense of your case.

Nope, it ISN'T fraud. It was MY MD writing in HER own office notes adding LATE ENTRIES to her OWN notes.

Looking at your quote below, it does not apply in this case. I am the patient, I sat there with her and had my journal with me of what I did each month and what we had discussed, it just hadn't made it into the record. By writing the date and time and "Late Entry" or "Late Addendum" it is just fine to add to a note. No third party payor had been sent copies of the records yet (because we were making sure what was needed in there was there BEFORE sending them to the third party payor). And what attorney? What defense of what case? I wouldn't be suing my PCP for anything relating to my weight loss visits.

From the American Health Information Management Association (ahima.org), THE authority (in the US) on medical documentation (thedoctors.com is a medical malpractice insurance company website):

Handling Omissions in Documentation

At times it will be necessary to make an entry that is late (out of sequence) or provide additional documentation to supplement entries previously written.

1. Making a Late Entry When a pertinent entry was missed or not written in a timely manner, a late entry should be used to record the information in the medical record.
   

• Identify the new entry as a "late entry"
  
• Enter the current date and time – do not try to give the appearance that the entry was made on a previous date or an earlier time.
  
• Identify or refer to the date and incident for which late entry is written
  
• If the late entry is used to document an omission, validate the source of additional information as much as possible (where did you get information to write late entry). For example, use of supporting documentation on other facility worksheets or forms.
  
• When using late entries document as soon as possible. There is not a time limit to writing a late entry, however, the more time that passes the less reliable the entry becomes.

1. Entering an Addendum An addendum is another type of late entry that is used to provide additional information in conjunction with a previous entry. With this type of correction, a previous note has been made and the addendum provides additional information to address a specific situation or incident. With an addendum, additional information is provided, but would not be used to document information that was forgotten or written in error. When making an addendum --
   
   • Document the current date and time.
     
   • Write "addendum" and state the reason for the addendum referring back to the original entry.
     
   • Identify any sources of information used to support the addendum.
     
   • When writing an addendum, complete it as soon after the original note as possible.

[*]Entering a Clarification Another type of late entry is the use of a clarification note. A clarification is written to avoid incorrect interpretation of information that has been previously documented. For example, after reading an entry there is a concern that the entry could be misinterpreted. To make a clarification entry –

• Document the current date and time.
  
• Write "clarification", state the reason and refer back to the entry being clarified.
  
• Identify any sources of information used to support the clarification.
  
• When writing a clarification note, complete it as soon after the original entry as possible.