Looks like I will have to start my 6 month supervised diet over again--advise please

Well, the surgeon's office called last week (I have been waiting to post this until now because I have been so upset about it) and basically they said that the doctor's monthly visit notes probably did not have enough information for the insurance.  The surgeon's office said that my PCP coule add addendums to the monthly notes but my PCP refuses saying that adding addendums is illegal and that her notes are fine (even though all we are asking her to add is a note that says "Discussed diet and exercise plan, continue as directed." and we DID discuss this at EVERY visit!!!).  I have one more doctor's appointment (next week) and then I will have seen my PCP 6 months in a row for surpervised weight loss but it looks like I will have to start over again.  The surgeon's office is going to go ahead and submit the information to the insurance after my appointment next week, but they think it is unlikely that it will be approved. If everyone who has been approved for surgery or had the surgery could just tell me what they did to fulfill the 6 month supervised weight loss so that I know what to tell my doctor we need to do, I would REALLY appreciate it.   I am so bummed and irritated--FOR GOD'S SAKE I WEIGH 472 POUNDS!!  I need the surgery!!   Thanks everyone!

Dang that is awful girl. If she doesnt want to work with you on what needs to be said and done, I would find another PCP. If she didnt do it right the first time she wont do it a second either. I sure hope they approve you. Ive got my fingers crossed for you.  ((((hugs))))  good luck

On September 26, 2007 at 11:02 AM Pacific Time, Melissa S. wrote: Dang that is awful girl. If she doesnt want to work with you on what needs to be said and done, I would find another PCP. If she didnt do it right the first time she wont do it a second either. I sure hope they approve you. Ive got my fingers crossed for you.  ((((hugs))))  good luck I know, I kind of feel that way too--but I REALLY like her otherwise and to be totally honest, I think her notes should be fine as well especially since Anthem (my insurance) will NOT give me any specific direction on what they are looking for--they just telling me (via emails that I have saved) that my doctor decides what is necessary for a supervised weight loss program.  So to me that should mean that if what we are doing is what my doctor decides is necessary and then if after 6 months of doing that my doctor thinks I should have the WLS then Anthem should approve it!  But I doubt that it what it will mean!  I think Anthem just doesn't want to tell me what exactly they need because then I would do that exactly and they would HAVE to approve me (and they don't want to approve anyone they can possibly avoid approving!).  So I am struggling with whether or not to switch doctors especially since my doctor is awesome otherwise!

    Wow, Maddie I'm so sorry to hear that. Look my last dr's appointment is next week also. Now my 6 month supervised diet was with the dr and the nutritionist. Every visit we discussed how I should eat and what my diet has been like.  I hope that your PCP can help you because you have been through Hell and back to get all this done. Good luck with this and keep us updated...............(((((((((((((((HUGS))))))))))))))))  

Call your insurance company and have them send you something in writing stating exactly what needs to be on your dr's notes in order to get approved for the surgery... I had cigna and did this with my PCP... so they knew EXACTLY what the insurance company had to have... maybe your pcp thinks you don't need it and if you take something in from the insurance they'll be more likely to help at least mine was... plus then you have something from the insurance company to submit showing that you had met exactly what they asked you to do and they can't deny you on that factor... Then if your pcp STILL doesn't cooperate... be a ***** girl!!! WHen niceness doesn't work... starting biting HARD! Don't start over FIGHT!!!

I agree with Jess on this one - call your insurance company as to what exactly has to be stated. I was lucky enough that my insurance only required simple statements such as "discussed weight loss" or "advised patient to loose weight" but I also asked my insurance company what exactly had to be stated just incase that wasn't going to be enough for them. So call and ask them - it never hurts to ask. Give them an example of what they might see and see what they say about it. Your calling and questioning it will also let them know what to expect and therefore they "might" be lientent(sp?). You'll never know unless you call.

I WENT THRU THE SAME EXACT THING- AND HAD TO START ALL OVER- ONLY WITH A 12 MONTH STIPULATION! BE SURE TO DO EXACTUALLY WHAT THEY SAY, CAUSE ANTHUM DOES CHECK EVERY" DOT AND WORD". I EVEN HAD TO FIND A NEW DR. THAT DID WRITE DOWN EVERY ATTEMPT AND WEIGHT/WEIGH IN, MY BP. AND BMI, AT EACH VISIT. I KNOW YOU ARE DISAPPOINTED, BUT HANG IN THERE, YOUR TIME WILL COME! I'M THINKING OF YOU. IF EVER YOU WANT TO "CHAT' JUST PM. ME! (((HUGS))) ELLEN

Were the doctors visits specifically for your supervised weight loss?  If so, I can't imagine how the doctor's notes wouldn't be sufficient.  But if the visits were for illness/injury, your weight loss was probably not the first thing on your doctor's mind.  If the visits were meant to be for weight issues, then the doctor really should do the addendum and write an appeal letter to Anthem.  It is tricky for doctors, because if the insurance company thinks they are altering medical records, the doctor can be sued for insurance fraud and dropped by the company.  Doctors have even been jailed for insurance fraud!

If I were you, I'd try submitting them. The worse thing that can happen is them deny you. MPlan didn't like the way my pcp kept notes & denied me (that was for 2.5 years of dieting) but Anthem had no prolem what-so-ever with them. Sherri

The visits were definitely for weight loss--and I even would state to the nurse at the start of the visit, when she asked why I was there, that I was there for diet and weight loss check.  I am going to go ahead and have Carmel Surgical Specialists submit the records and just keep my fingers crossed.  It wouldn't be the worst thing ever for me to have to do another six months--that would put me into March, which would put me AFTER the huge workload in January and February at my work AND I could have my tax refund check which would help out financially--but I would still prefer to have the surgery approved sooner! Thanks everyone for the advice--I still would like to know what each of you did for your supervised weight loss so that I can make sure I do something like other people who have been approved.