I'm so confused......Documentation!!!

Hi all, well I just got off the phone with my PCP's office and she told me that she called my Insurance Company and they told her in order for me to get approved for the Surgery, I would need a Physc Evaluation and 6 months documented weightloss history to get approved......What the heck does that mean.....the Spectra Healthcare told me that I need to have 6 months Consecutive Medical Supervised Weightloss to turn into my Insurance Company to get approved....I'm so confused that I am in the sad mood of giving up......Please help..............Hugs, Maria P.S. My Insurance is Healthease which is a PPO of Medicaid of Fla.. They all have there own rules and regulations

They told you exactly what they need and they mean exactly what you said. They want 6 months of documentation from your doctor that says your doctor supervised a weight loss program for you. It cannot just be a letter that says the doctor was aware of your weight problem. You have to have 6 visits to your doctor for 6 months right in a row where your doctor discussed your weight loss and dieting efforts and your doctor needs to document these visits in an office note. A psych eval is usually not a big deal, either. You go to one of the approved psychs (in my case a psychologist was allowed, and that's good because they are cheaper than a psychiatrist) and it's a simple test most of the time. Don't let this throw you!! Things can be much tougher than this! What your insurance company is asking for is NORMAL and very routine. This surgery isn't approved without some effort on your part, and that's good, because you have to be willing to do your part to make the surgery successful. This surgery isn't a cure for obesity, it's just a tool and you will always have to do your part one way or the other. If you didn't understand any of what I said, please post again. We're all here to help you! Jan

Basically what your PCP and the insurance company are saying are the same thing. Many insurance companies require six consecutive months of a diet followed/monitored by your physician, you'll then have to provide those doctor's records to the insurance company. Many insurance companies also require a psych eval to prove you are mentally ready for the surgery and aware of it's risks and life-long commitments. You should find out now if that eval is covered by your insurance company so you wont be disappointed, many of us had to pay for those sessions ourselves because it wasn't covered by insurance . Don't get discouraged, you are just seeing some of the hurdles to getting approved, but it isn't hopeless ! The insurance companies just want you to give up so they don't pay for surgery ~ don't let them have that much control over your decision .

I had to have 5 years of weight loss records! Fortunately I kept my records from weigh****chers, which I copied and my doc placed them in his chart. Also I had been working with TOPS and weighing in every week for 2 years and had that record which my doc also copied. These he sent in with his records that had written obesity, overweight on my visits etc. He also wrote a letter stating he had been supervising my weight loss while I was at these organizations. I got approved! Don't give up....just do it. Sally Kate had to go through this too, and she is approved. So we will cheer you on, you can do this girlfriend! Blessings, Tami

Wow you are Lucky Tami Both my PCP & my Surgeon's office said my Humana Insurance wouldn't accept My four years of Wigh****chers records, which I stopped this past July. I'm just finishing my first month of the six month doctor's supervised documented diet. Mike