Question about the dr. supervised diet documentation

My question is, what exactly do they want to see in the Dr's chart notes?  I want to make sure my Dr. is very clear on what they are looking for so i don't get rejected.

I am going through medicaid and it states on my sheet that they require a 9 month Dr. supervised diet documentation.

So far, I have visited him for the 9 month's they require, at every visit we have spoken about my diet, i am doing low cal and herbalife which is a meal replacement.  We also speak about my exercise, what i am doing for exercise and how often.  They weigh me and take my vitals.

So if anyone can provide me with information i would appreciate it, as i have my next appointment in a few days and i want to give him the paperwork.  But i also want to be clear on what they are looking for specifically in his notes.

Thank you.
 

Unfortunately most insurance companies have VERY specific requirements about what needs to be in your medical chart for this suprervised diet.  And if your doctor doesn't get it right... you will probably have to do it all over again (I did!).

*** Call your insurance company and find out EXACTLY what they require. Mine had specific things that needed to be recorded each month. Diet exercise discussion of plan and monthly progress and specific changes... blood pressure, weight and BMI check each month .... consideration of pharmacological alternatives (diet pills) ..... psychological changes, etc. I had a list that I provided the doctor and we checked it each month when I went for my weigh-in. It's essential that these discussions are recorded in your medical chart. Talking about it is not enough - it has to be written down.

*** If your doctor hasn't been doing it right from the beginning, he can not ethically go back and alter his office visit notes retroactively.

Good luck!
Pam

I figured as much,  How can i force a dr. to write it down each month?  How can  you be sure what your dr. is writing down each month?

You can only tell them what you need and ask them to do their job and record it.

It is unfortunate for me that i have a really lazy and horrible dr.  This IS the second time i have done the 9 months with him because he screwed it up last year (they claimed last year to have lost my medical records). 

I have called my insurance and they said all they wanted was a record each month that i did exercise and was weighed each month by my dr.  I asked for it in writing and they said they do NOT have any documention that they can send me.

I know for a fact that is a lie, however after talking to 3  (yes THREE) different people at the insurance place, i could not get ANYTHING sent to me in writing or have it clearly spelled out for me other than to say what i mentioned above.

I am going to be mega pissed if i get disqualified again because this will be my 3rd time attempting it if i get turned down again.

Thanks for the good luck wish, i have a feeling i am going to need it.

 Justin  

I'm sorry... I didn't mean to make you feel discouraged. This silly insurance crap is the most frustrating part of this whole surgery thing. And you're right, all you can do is tell your doctor what needs to be done and hope he does what he's suppose to. Making sure he understand why those notes are so essential might help him (compel him?) to do his job right. I personally didn't give my doctor a second chance... once he screwed up, he got fired and I found a doctor who helped me. 

I hate it when insurance companies lie -- of course they have that info in writing and they are actually required to make sure you have your policy in writing available to you. You might want to contact your human resources department at work for help in getting the info you need.  Basically you just need the exact criteria for insurance approval for surgery so you can use it as a checklist -- the diet part will just be one thing on that list. 

Keep us posted on how it goes. 
Pam

Thank you Pam,

I have just had yet another setback.  The psychologist that gave me My MMPI claims that i need to attend 14 sessions with him before he will resubmit his notes for re-approval. 

This is extremely heartbreaking for me as i need this surgery desperately.  A medication i occasionally take for a sleep disorder was said to have caused a 'red flag' and he is 'concerned'.

What is worse is, my own psychologist that i have went to for the past 3 years approved me, but the hospital will not accept any outside psychologists other than their own.  To make matters worse, it is a 2 hour drive and this psychologist does NOT accept my insurance. 

14 more sessions that i have to pay for, 4 hour drives (you know the cost of gas), well over another year wait meaning i will have to REPAY and retake the MMPI because it has to have been taken within the past 12 months.

Does this seem wrong to anyone else?  Why should i be forced to use their psychologist and pay for 14 sessions with him, just on his word alone and i still may not be approved :(

 

Justin - 

Wow! This seriously sucks! 

What hospital are you using?  Which surgeon?  And what are the possibilities of changing to someone who is more willing to work with you?  Is this psychologist a specialist in bariatric patients? And how many patients has he seen who are planning WLS? 

It seems to me that a surgeon would be more willing to accept the recommendation of a psych who has seen you for several years over someone who only saw you once and doesn't know you personally. This would be a "red flag" of my own. 

Pam

I am going to send you the specific informatin in a private message.  I dont want to compromise any potential i may have for the future.