MEDICARE/PRIMARY/LETTER FROM INS. DEPT. BARIX CLINIC(repost)

Original Post by Tammy Gibler at 11:27 AM PST on 08/10/2005 Pecatonica, IL Well, after 2 weeks of trying to get ahold of the insurance lady in Minnesota...I got a lovely letter in the mail today from her instead. Now that answers why she does not call me back! I'm just not sure what to do here. Just seems like there are too many hoops to jump through for people and places. I was surprised at the letter. I am on Medicare which is primary because I'm on disability for Bipolar 1 Disorder. I am also covered on my husbands insurance through where he works. On to the letter now. Love this sentence "Based on our past experience with Medicare, we have found that generally there are REQUIREMENTS that you MUST meet in order for Medicare to PAY for this surgery." They can't review my case for "medical necessity" until they have the following information.... #1 Past 5 years of medical records......dr. notes, hospital records, surgery records, specialist visits, findings and recommendations #2 Summary of health status letter from my primary care physician to include......current & past medical condition status, current & past medications and ??(what the heck does this mean)?? ability to "withstand" major abdominal surgery & undergo anesthesia #3 psychological evaluation (by a psychiatrist or psychologist who perferably has experience in counseling seriously overweight people. Mental status, psychosocial history and assesment results. #4 12 months FAILED SUPERVISED DIET attempts ( what in the h-e-double toothpicks does that mean?) MY WHOLE LIFE IS A FAILED DIET ATTEMPT AND NOW SOMEONE WANTS SUPERVISED DOCUMENTATION THAT, YES...IN FACT.........I CAN FAIL A DIET!!!!!!!!!! What am I to do? This really has got to be some kind of a very cruel joke! I am hurt by this stupid letter and I know I shouldn't be! I've had too many visions of myself being healthy back to the way I was 19 years ago when I got married to the most wonderful man in the world and now it's all been dashed. Maybe I'm just kidding myself. I have gotten no where. I was excited about the seminar I went to and excited about the consult with the dr. and now where am I? I'm no where. These insurance companies got you right where they want you. Dang-it! I'm just upset and mumbling now so I better go. Thanks for listening.

Tammy take heart about every doctor requires this stuff. just take it one thing at a time... Contact every doctor you have seen in the last 5 years explain why you need the medical records and they will give you a copy of them. BTW they are yours they have to give them to you... Ask your regular doctor to write a letter.. and tell them what you need in it.. quote the letter you got.. they will handle it... Call a head shrinker make an appointment for the consult.. I would ask them if they have experience writing an evaluation for WLS... that helps.. Sit down start making a list of every diet you have ever been on estimate how much you lost then how much you gained back how long you were on it.. are any of these diets through places like "la weightloss centers" or any doctors? if so get copies of your records from them.. You will be made to jump through hoops.. so keep reminding yourself how bad you want this... This surgery is extremely expensive and public aid/ medicare/medicaid is not just going to say "sure we're gonna pay out 45K for you to have this" without some serious work by you... Atleast you have hope to get approved just keep plugging away and do what they expect you will not be able to get past any of this stuff so dont stress and just do it!!! hang in there!!! Debby

Hi Tammy, I agree with everything Debby said. These road blocks are set up in the hopes you will go away and or give up. DON'T!!!! This is to important. You hangin there And take it one thing at a time, one day at a time and your day will come I promise. Take care, Kathy

Hi Kathy, Thank you both for your encouragement. That means alot to me. I just don't know what to expect with all of this. I am not really sure where to go from here. I do have an appointment with my PCP at the end of August and I will take a copy of the letter with me. You all are right. I need to just take things one little step at a time here. It's not anything that's going to just happen over night. Be blessed in all you do. Tammy Gibler...Pecatonica, IL.