insurance requesting 5 year weight history with diet progress

evjesstate
on 9/28/12 3:34 am
DS on 12/18/12
My insurance is requesting five year of medical records with weight and diet progress notes. 
Does that mean they can still deny my surgery?

I have not used a Dr. to help with weight loss, except for trying diet pills a few times.  I have always tried losing weight myself by low carb or low calorie. 

Because I do not have notes/medical history from Dr. does that mean they can deny surgery?  I have been well over 220 pounds the last five years, now at 320.

Was hoping someone with experience on insurance can give me some reassurance feeling nervous I may not get the surgery:(
larra
on 9/28/12 4:29 am - bay area, CA
You need to review your insurer's exact requirements for bariatric surgery. There are many different policies out there, often with very different requirements. Do not trust info anyone gives you over the phone - you need to review the specific policy for this.

There are some policies that do require a 5 year history of being MO. This is often difficult for people to document, which is probably why they require it - it's a very convenient way to deny people access to medical care. Many MO people don't go to the doctor often, or don't get weighed in when there. However, this is different from whether or not you were doing medically supervised weight loss for the last 5 years.

So get your policy for the details, and whatever you do, don't give up. Denials can be appealed, often successfully.

Larra
southernlady5464
on 9/28/12 6:42 am
Check with other doctors you have gone to besides your PCP...endo, ob/gyn, etc.

The more you gather, the better off you are.

Good luck.

Liz

Duodenal Switch (Lap) 01-24-11 | Surgeon: Stephen Boyce | High weight: 250 in 2002 | Surgery weight: 203 | Lowest weight: 121 | Current weight: 135 | Goal weight: 135






   

BALintner
on 9/28/12 8:37 am - IN
 My insurance also wanted last 5 years. I simply went back stating the different weight lss things that I tried and how long I used them, approx. weight lost and then gained back. Ex. Weigh****chers, 1/11-3/11, 20 lbs lost but gained back. Just go back 5 years.
A. C
on 9/28/12 12:02 pm
Mine required 1 page per year from a Dr. for 5 years of WL history.

I think it's just something Utilization Review has to have.  More beaurocracy if you ask me.  All of our info goes the the Medical Information Bureau.  I do not know.  I'm sure somehow they have to prove that you haven't just put on the pounds in the last year.
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