Co-morbidity: PCP signed off on me previously having GERD but I don't have the original diagnoses. Problem?

[Jumanna 3]

I am in the process of getting things together to send off to insurance. My insurance requires me to have one co-morbidity and mine is GERD - the problem is my brother in law, who is a PCP, told me that I have it. I was not his patient or anything, he was just over my house to help me out and took me to get OTC medication for it. I arises sometimes still. My current PCP signed off on it but I am afraid that insurance will want proof of my original diagnosis of GERD (two years experience with it to be exact).

If my PCP signed off on it, will insurance require me to give them original documentation of it from 2016? Like I said, I dont have any documentation because my brother in law told me I had it. I just dont want that to be the reason that I dont get an approval. What do you all think?

[Mhy12784 423]

Does GERD count for you? With most people/insurances it does not count.

Have you had an endoscopy? Have you been prescribed medication for GERD?

[Frustr8 7,886]

I have had both, diagnosed.with GERD, had it confirmed per,2 endoscopies one in June 3015, another December 2017 am currently on Dexilent which my gastrointestinal specialist calls "the Ferrari of tummy medicine" It is,listed as a secondary comorbidty on my records and Medicare my primary insurer knows it. Yes it is not usually a primary comorb but it can be listed as a contributory secondary. 😝,

[Jumanna 3]

My insurance acknowledges GERD as a comorbidity, and its the only one that i have! from what i know and what my program specialist has told me I dont have to do any additional tests. I just dont have the original documentation that diagnosed me with GERD - however, my PCP put that comorbidty on my clearance form. I just hope insurance doesnt dig any deeper!

[Mhy12784 423]

1 minute ago, Jumanna said:

My insurance acknowledges GERD as a comorbidity, and its the only one that i have! from what i know and what my program specialist has told me I dont have to do any additional tests. I just dont have the original documentation that diagnosed me with GERD - however, my PCP put that comorbidty on my clearance form. I just hope insurance doesnt dig any deeper!

Have you ever had an endoscopy or been prescribed medication for GERD ?

I know being prescribed medication is the other factor that insurance companies frequently look at (ie HTN only counts if you're prescribed blood pressure medication)

It would look very fishy to me for a provider to diagnose a patient with GERD and not send them for further testing or prescribe medication.

[abefroman329 704]

I was diagnosed with GERD 13 years before my surgery and was never asked for evidence of the diagnosis. I also had hypertension, type II diabetes, and obstructive sleep apnea, so I probably would’ve qualified even with those.

[GassyGurl 428]

Are you sure you havent had it for years and managed it with Otc medications like prilosec and tums? And forgot to have your PCP note those medications in your chart?

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