Insurance Help Needed

sarcar · April 8, 2005

My insurance will cover the cost of surgery if I can prove that under doctor's supervision I attempted & failed at a low calorie weight loss program & excercise program for a minimum of 6 months. Unfortunatley, my doctor retired and when we did all the this, didn't document real good. I'm in Dallas - not that it matters. Any suggestions?

Alexandra · April 8, 2005

My insurance had the same requirement. Even if your doctor retired there should still be some notes from the last few years, but if you and he didn't talke specifically about your weight the notes won't matter much.

Did you see any other doctors in the last couple of years? A gynecologist? Urologist? Allergist? Dermatologist? Any of these might have made notes about a health problem related to your weight.

If you don't, the good news (and it is GOOD news) is that you're still only six months away from an approval. Call a doctor RIGHT NOW and make an appointment, and when you go in talk about your weight and ask for a diet plan. Then go in once a month to be weighed and talk about your progress. Before you know it there will be a six-month record of your attempt at weight loss and you're there! And if you lose weight during this time, you'll be that much healthier for surgery.

I'llsucceed · April 8, 2005

If you don't, the good news (and it is GOOD news) is that you're still only six months away from an approval. Call a doctor RIGHT NOW and make an appointment, and when you go in talk about your weight and ask for a diet plan. Then go in once a month to be weighed and talk about your progress. Before you know it there will be a six-month record of your attempt at weight loss and you're there! And if you lose weight during this time, you'll be that much healthier for surgery.

Unfortunatley this is THE BEST ADVISE. I am having that has one of my problems has well- Even though I have YEARS of previous Doc followed diets. I was without insurance this past year & they said I must have Documents from 2004. Go Figure-all the other 15 years don't count as much:0)

I sure hope you can find someone else who saw you & documented something. If Not I hope you get an appt right away & that times Flies By for you!--Best of Luck!

sarcar · April 8, 2005

What is it that the insurance company is looking for. That you can stay on a diet for 6 months, that you can lose and then gain back, that you can't lose even on a diet, that you're dedicated to loosing?????

Debbydo · April 8, 2005

Hey he's only retired not dead. There has to be a way to get intouch with him or another physican that pruchaed his practice or something. Medical records are optanable in NY for 7 years. He might be very happy to document your conversations and attempts. You never know.

sarcar · April 8, 2005

She is young - just retired to have a baby. Her nurse still works at the practice and keeps in touch with her. I have a call into her. Thanks...

Debbydo · April 8, 2005

Goooooood Luuuuccckkkk

What a sexist I am - I assumed the MD was a male. Sorry:cry

Alexandra · April 8, 2005

What is it that the insurance company is looking for. That you can stay on a diet for 6 months, that you can lose and then gain back, that you can't lose even on a diet, that you're dedicated to loosing?????

People think this requirement is onerous, but to me it makes sense. It serves no one for people to wake up one morning, suddenly decide that surgery is going to be the answer to all their problems, and have the insurance industry bear all of the cost. This six-month record of medical supervision shows several things: that the patient was concerned enough about his weight to seek medical attention; that the patient is/has been willing to examine his own behavior and try to incorporate new habits (both of which will be REQUIRED for WLS to work); and that the patient is reliable and participating in his own care. All of these things seem like no-brainers, but the insurance carriers really do have some good reasons to screen the WLS-seeking population.

Believe me, I'm no apologist for the insurance industry. It appalls me that WLS can be excluded completely from some plans. But I do think the bar should be high for people seeking it, and if this is a requirement it seems fair to me.

sarcar · April 9, 2005

Well, I got a reply back from the nurse that worked with my doctor and works with the doctor in the office that I transferred to. She said that there are records showing weight loss, dieting, exercise for several years back. She has had to write these letters before and believes there is enough documentation of weight loss/gain/loss/etc. showing that I have been attempting this for many years now. Hopefully this will get me past that point and then to the psych evaluation from a non-surgery center. Wish me luck.

paula · April 9, 2005

Well, I got a reply back from the nurse that worked with my doctor and works with the doctor in the office that I transferred to. She said that there are records showing weight loss, dieting, exercise for several years back. She has had to write these letters before and believes there is enough documentation of weight loss/gain/loss/etc. showing that I have been attempting this for many years now. Hopefully this will get me past that point and then to the psych evaluation from a non-surgery center. Wish me luck.

During my Quest for approval, I found that the medical personel in all the offices I went to - were MORE then willing to help!

I went over and beyond trying to get documentation of previous diets. Like you, my former doctor (OBGYN) had retired and (although I really didnt need it, I just wanted it for more ammo) I did some phone work and found the records building he sent his records to. It cost around $75 to get copies of my entire chart with him, but it was well worth it. These records showed 4 years of charted diets, with presriptions of diet pills - even phen-fen.

Basically, after everything was over, these copies are now in my chart with my current OBGYN. Its good to have your medical history put together!

sandie1958 · April 9, 2005

sarcar:

what insurance carrier do you have? i have cigna they reqire the same thing. so i went to the dr 2 wks ago to start it being documented. then i got a letter from my cpmp. saying may 1 we will switch to united health care i heard they dont require it but i am going to keep going once a mo. to get weighed & have it documented just in case. good luck sandie

sarcar · April 11, 2005

I have First Health. The doctor thinks that there is, in fact, enough documentation to cover this requirement. So now all I need to do is to get a Psychological evaluation by an independent licensed psychologist or psychiatrist not affiliated with the surgical group.