BC/BS denied due to lack of documentation- help!!!
Hi everyone!
I'm new here, first time posting. I've come to the boards several times for research and to see what WLS is really like, finally made up my mind almost a year ago to actually go through with it. 5'0 and morbidly obese. I turned all my info into my insurance BC/BS of IL, and I was denied due to lack of information in my 6 month medical diet documentation. The problem is, I am under a serious time crunch. I will be losing this insurance soon, in the next couple of months due to a change in job. The doctor I went to for this 6 month diet didn't completely fill out the notes. He put my weight on every note, but sometimes just put "talked about diet", "gained weight". He wasn't specific on every note so they denied me. Everything else was fine. WHAT DO I DO???? I talked to my dr regarding the notes and he said he can't resend in notes with new info. The info that is needed were things that we talked about during those 6 mos, I'm not sure why he didn't include all of it in the notes. I can only assume that he just scarcely jotted stuff down while we talked. I was seeing this doctor for another health issue at the time and he agreed to do the 6 month diet for me, since I was seeing him anyway. Now I am heartbroken and afraid that I have missed my chance, again. Considered WLS about 3 yrs ago, but the insurance I had then pulled a fast one and the option for the surgery was eliminated soon after I inquired about it. I thought I had done everything right this time. Checked with my insurance to make sure what the requirements were, made sure that I did everything they asked. 5 yr weight history, psych eval and 6 month diet documentation, nutrition classes were the final step to be done a couple days prior and post surgery. Now, I am absolutely devastated! I'm beginning to think maybe its just really not meant to be. But, I NEED this surgery and I really believe that I deserve a better quality of life than I have right now. IS THERE ANYTHING THAT CAN BE DONE?
I'm new here, first time posting. I've come to the boards several times for research and to see what WLS is really like, finally made up my mind almost a year ago to actually go through with it. 5'0 and morbidly obese. I turned all my info into my insurance BC/BS of IL, and I was denied due to lack of information in my 6 month medical diet documentation. The problem is, I am under a serious time crunch. I will be losing this insurance soon, in the next couple of months due to a change in job. The doctor I went to for this 6 month diet didn't completely fill out the notes. He put my weight on every note, but sometimes just put "talked about diet", "gained weight". He wasn't specific on every note so they denied me. Everything else was fine. WHAT DO I DO???? I talked to my dr regarding the notes and he said he can't resend in notes with new info. The info that is needed were things that we talked about during those 6 mos, I'm not sure why he didn't include all of it in the notes. I can only assume that he just scarcely jotted stuff down while we talked. I was seeing this doctor for another health issue at the time and he agreed to do the 6 month diet for me, since I was seeing him anyway. Now I am heartbroken and afraid that I have missed my chance, again. Considered WLS about 3 yrs ago, but the insurance I had then pulled a fast one and the option for the surgery was eliminated soon after I inquired about it. I thought I had done everything right this time. Checked with my insurance to make sure what the requirements were, made sure that I did everything they asked. 5 yr weight history, psych eval and 6 month diet documentation, nutrition classes were the final step to be done a couple days prior and post surgery. Now, I am absolutely devastated! I'm beginning to think maybe its just really not meant to be. But, I NEED this surgery and I really believe that I deserve a better quality of life than I have right now. IS THERE ANYTHING THAT CAN BE DONE?
I had the same thing happen to me, what ended up getting me approved was a rather "hot" letter from my doctor to the insurance company. I also got my HR department involved. Some of the other options is see if the insurance company and your doctor will do a peer to peer conference. This is where the insurance reviewing doctor and your doctor get on the phone and discuss your case. Your doctor can not rewrite his notes by law. What ever you do DON'T GIVE UP there are options available explore all avenues. It took me four years and a job change but if I can get approved any one can. Good Luck
MrBill
That's weird. I had the exact same thing happen to me. (I have BCBS of NJ) I attended the LEARN program for the 1st three months, then found out I needed 6 months so I went to Weigh****chers under my PCP's supervision, of course. Everyone turned in their info and I was turned down. What I ended up doing was sending in all of my food journals. The dietitian in charge of the LEARN program just sent a letter with my weight loss. Anyway, we sent in all of my food journals and that made them happy. Good Luck.
Hugs, Peggy
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