Back to square one!

Well everyone...I have the hardest insurance in Michigan to get this procedure approved. My Doctor did not keep good enough records of my diet documentation. My insurance, Blue Care Network, requires at least twelve months of documented diet within the last four years. Well, my Doctor didn't write my weight down in my records everytime I came in, so the staff at the clinic are certain that I will get denied. So, Monday I march back to the doctor to start yet another diet. I hope in six months I will be on the loosing side of things around here. I want to say that this forum is awesome. I had a great time reading all of your stories, but because my surgery doesn't look like it is coming anytime soon it is very disappointing now to come here. I will talk with you all in about six months and I want to see some pictures. God Bless and keep loosing. Hugs to everyone, Tammy

Tammy, don't give up hope yet. You never know until you actually hear from the insurance. They could surprise you. Maybe you could take the dates you were weighed and graph them and send it to the insurance co. While there are dates with missing weight info, don't chart the missing info and it'll show your lack of success overall. Does this make sense? Sheryl In the Zoo

Thank you, you are so right. I found out too that my PCP only sent the last two years of my medical records. So on Monday, I will have to see what the reason was for not sending all four years. But I never thought of sending all my personal journals. I have been doing that all my life. I am not giving up, especially after all of these responses from everyone. You guys really made me feel important and that I do matter. Thank you again, Tammy

Tammy Cheryl is right, DO NOT GIVE UP!! Just because your doctor did not document every weigh in does not mean anything (read my profile) I have BCN, they denied me 2 times until I went to an in person appeal on June 8, 2006 on June 9, 2006, I was called and told I was approved. My doctor did not document each time I went to see him for my weight and I started to see him specifically for weight since September of 2005, even then, BCN said those records were not enough to show documentation of attempted weight loss. Have you ever went to like Medical Weight Loss, Weigh****chers or any other weight loss clinic where they documented your attempts within the last 4 years? If you have, I would go get copies of these records as well and take them to your surgeon for review. Good luck and if you need any help, please let me know. (((((((HUGS)))))) Licia

Wow, you have been through a lot. Do you have any medical problems from being overweight such as diabetes? I have got it all. I go to see my Doctor and I am hoping that he will write a letter for me too. He said if my sugar levels didn't go down that insulin was my next step. I have been on insulin before, in fact, it is easier to manage your blood sugar levels with it, but I used it as an excuse to eat all the bad stuff and stay heavy. I will fight, and thanks to all of you and my husband. If it takes a personal appeal, I will do it. Thank you. Tammy

Hi Tammy, no I guess I am fortunate enough not to have developed diabetes, yet. Since it runs in my family, I have a very high chance of developing it if I cannot get the weight in control. My father is a insulin dependent diabetic and has had his right leg amputated from complications of this disease. I hope your doctor would write a letter for you supporting surgery since you have other co-morbs.

Hi Tammy, By the sound of it, you have my old dr!! I just left them because Dr Aguino wouldn't give me a referral for a upper GI that Dr Obeid asked for. Also, Dr Aquino wanted me to switch to BC/BS to have it done. I have been going to that practice since my hubby & I got married 37 years ago. My hubby was Dr Adams' first patient when he was about 9 years old. My mother in law worked cleaning his home for many years to pay for his services. I love Doris & Sheila too. I miss them so much but I had to do what was going to help me. Its sad that I had to switch Drs just because of that one test that Dr A wouldn't give me a referral for. Good luck with your referral. De

I agree Tammy, don't give up yet!!! Let them deny you if they want to, then appeal, if denied again, go for the in-person appeal and I bet you get it. In the meantime, yes, continue to go and get documented weight loss/gain documentation, but to tell you the truth, are you sure you want to go to the same Dr.? They didn't seem to keep very good records and I'd hate if you get thru this 6 months of appts. and not be documented right! Just a thought. Also, as someone said, get all the documentation from any other weight loss attempts like weigh****chers, jenny craig, etc... I had BCBS PPO, which I know is easier to get approved than BCN, but they excepted just my Weigh****chers weigh in booklet for proof. The graph, whether it has all the dates on it or not, is a great idea too....shows them in a nutshell how you have been progressing (or struggling) with your weight, with the Dr.'s documentation to back it up (as much as he has). DON'T GIVE UP TAMMY! And I can imagine it could be depressing coming here when you feel so defeated, but we'll support you all the way, no matter how long it takes! YOU WILL GET SURGERY!!! Remember that. It just might be a little longer than you hoped for....I remember waiting for my paperwork to clear, etc. and even though I didn't have to wait that long, it is excrutiating. I guess maybe think of it this way....it took us a long time to get all this weight on, so just a few months to wait to get rid of it for good is not so bad. (I know, easier said than done!) We will be here for you with ideas, support and love. Hang in there and best of luc****ep us posted! Hugs, Theresa

Thank you for your response. All of this attention sure makes me feel important. It makes me feel like I am worth fighting for. As for my Doctor...He is a great guy, just always in a hurry. I just have to slow him down and maybe make eye contact. I have been going to the same Doctors office for 34 years. I have seen two physicians die. But the nursing staff knows me and my whole family. I am very comfortable with them. Doris the RN gives the best shots, just like butter. I did got through weigh****chers and Formu 3, but I didn't keep my record books. However, I have kept journals and I certainly will try to submit them now. Thank you again for being here for me. I was feeling pretty low.

Hello! I have BCN also and I am going to be back at square one also. My PCP talked to the person reviewing my records for approval and he told them he never gave me a referral to go see my surgeon. He not only gave me a referral, his office also faxed over all of my medical records. What a fool!!! I just happen to have 14 months of documented Weigh****chers. Somewhere on these message boards there is a form to take to your doctors and it has all the information you will need to have documented each time you go to the doctors. They say to take it to your doctors office and have them put it in your file and everytime you go to see him the doctor is supposed to fill in all the information. Maybe you should post something asking for the form...just to keep your records straight. Keep your head up. Stacey