As I have posted before I am a cm and some times I approve for gastic procedures

We have a check list and one of the doc sent a packet of records over a hundred pages it was as if he was reading the ins company I work for mind.  It was awesome I simply went down the check list and it was all there often it is the 3 months participation of medical supervised wt loss.  Every thing was there I wondered if this site educates the pt who then educated the md of what needed.  It is so nice to not have to send it back to the medical director as every point was addressed.  Education on pre and post op every thing.  I was so happy I wanted to call the mbr but that is not my place all I can do is call the provider.  It makes me feel good to know it made some ones day as I remember when I knew I had every thing in place and it was finally time.  In this instance it was for a sleeve I hope the person is successful.  The person will be in my prayers tonight and I am so happy we have this site to turn to.  This part of my job is very small but I tend to know the difficulty the pts have gone to and I want to approve approve approve:)  I appreciate all of you who have been supportive of my roll as I hate when I have to deny someone until they have he 3 months monitored wt management.  Specifically Major mom thanks for putting this perspective for me as I want to please every one:)

Donna

If you like this, then you'll really love dsfacts.com, where we refer a lot of newbies who want a good overall view of life with the dS.

I hope it does get more clear for patients to get the procedures they need approved. All the hidden loop holes are so frustrating. I'm glad you have good cases where they put a great packet together . Makes your day.   : )

--gina

 I had one who was a revision who did not have the psy eval done the second time around and I knew the medical director was going to deny.  I was pushing for that one because the mbr had a hernia and a prolaped stomach and needed the band removed personally I hated the idea of having to have 2 surgeries and the risk of anesthesia but unless the psy eval and 3 month monitored wt loss is completed it would not be approved.  For the most part 98 % I approve but when it sticky we have strict guidelines I must send it back to the medical director and for good reason as I am a nurse and he is the doc for a reason.