Question:
BCBS IL wants documentation. I don't have any. Now what?
I went in January for a plastics consult and I am all hyped up about the possibility of going for it this summer (not teaching summer school this year). I got a letter from Blue Cross today asking for documentation of rashes that I have for the past 24 months and anything about a hernia. 1st off, I never claimed to have a hernia and I didn't think I had one when I consulted the PS. 2nd, I have always been embarrased by the rashed and taken care of them myself with OTC meds until February when I realized that might help get insurance to pay for tummy tuck if I could have the doc write it in my notes. That doc did, but said he was against plastics and would not write any letters or deal with insurance companies. I left him and went to a new doc who has documented the rash twice now, and prescribed OTC meds to help. He also thinks my back pain could be related since my body has been thrown of proprtion. He seem supportive in my desire for PS. What exactly is BCBS looking for? I think I need the new doc to copy my chart and send that in. Should I take pictures of the rash in question and then send that along? This is taking forever and I want to get it done! — Heather M. (posted on April 24, 2005)
April 24, 2005
Hi Heather,
I still am pre-op, but my pcp told me already that when I get a rash or
anything to come to him because it needs to be documented or they won't do
it. You need to find a doctor that is on your side. You pay them, they
should be listening to you. What you can do is take pictures of it
everytime you have one and put the date on it. Most importantly though find
a different doctor.
Heather Tuttle
— Stormy71
April 24, 2005
whether or not your dr is supportive of plastics he/she has a legal
obligation to document anything and everything you see him about. they also
have an obligation to release those records to you or who you designate to
recieve those reords.
— **willow**
April 25, 2005
Hi Heather, first off congratulations on the great job. Did your ps take
pictures to submit to the insurance? You should have qualified easily, 1.
for bcbs to pay for RECONSTRUCTIVE surgery, you must be at least 1 year ost
op wls, 2. lost 100# 3. maintaining your weight, 4. near goal or at goal.
4. pannus must hang below the mons. Has the back pain been documented?
You may need for your pcp or ps surgeon to write all of the above info for
your insurance co, and let them know you took care of the rashes on your
own. I put in my letter I used hand sanitizer to keep the rashes under my
belly and breast in check, and also vinegar/water, helped also. I was
approved in less than 2 weeks, they paid for my panni, and breast
reduction. good luck. Rosemary
— wizz40
April 26, 2005
You have a right to all of your medical records. Go back to the doctor who
would not support you and get copies of your records. Then at least you
will have more documentation for your cause. I had to do that before I had
my WLS. Good Luck!! I am only four weeks out and losing very slowly.
— Barb N.
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