Update on Insurance issue. (long)

Well I got my letter a few days ago. Called Tarra at OHSU she said to fax it to her, so I did. The letter says that I was denied because "No documentation of a 3 year history of weight reduction attempts was submitted, which plan requires" So Tarra called me yesterday saying that I need to come up with more records. I said I gave you 5 years worth of dr's records and weights and Jenny Craig documents. I don't have anything else in writing. I asked her what she submitted and she said she didn't have any Jenny Craig records. But I know for a fact that I gave them to the NP. Guess they didn't get those! How do you prove you tried Atkins, Weight down diet, Weigh****chers. I did do b6 & b12 shots but I don't remember the name of the place and it was in Arizona..I can't just drive by and hope its still there ya know? So she told me that I was on my own and that I can appeal on my own and keep them posted! OMG I can't even believe she just left me out to dry like this. I don't have a clue what to do or where to start. So I called the insurance company and asked them. The guy was very nice and helpful! He told me to get a letter from my dr in Arizona if possible and submit my jenny craig stuff. So I called this morning and my dr's office said they would write me a letter YEA! I hope that is what they need. Also I tried to get my records from the gym I was attend then but they have since changed hands and they don't have any of my old records! So that sucks. Another thing, I called Tarra to get a copy of my file so I could submit it all the way I wanted too. She informed me that she was happy to get the OHSU records but not she wouldn't give me any of my old records and that I had to request them again. OMG the only reason I don't have a copy is because the NP filled out the paper with there address and fax number and NOW I can't get them? I have to request them again and wait 2 weeks!?? That is just so unbelievable to me! So here I sit waiting to get my records again. so I can submit my OWN appeal. I wonder if I'll have to do my own surgery too? LOL well thanks for listening if you made it this far. Rebecca ~ Beaverton

Wow Rebecca. Sorry to hear you're having such a hard time. I faxed all my stuff to OHSU, so I have a copy of every scrap of paper I sent them in my file. Can you call the Jenny Craig Center you attended and get your records? They would have to have something indicating that you had been there. I still have my lifetime membership card from Jenny if I ever need to get my records. Also, your WW Center might also have at least a record that you had attended. I think most insurance companies want medical weight loss records, meaning that you can't use WW and JC, but some will allow that. At any rate, I hope you can get it all pulled together and sent up. I know that the medical offices (like Tara's) are so busy that they can't go requesting records for everyone -- as a matter of fact, due to all those privacy issues, they can't ask -- you have to do it. Bummer, but a fact. Best wishes for getting all the paperwork together. I bet once OHSU has everything, they will help you deal with the insurance company. Linda

Rebecca, I'm sorry to hear about your insurance denial. I have worked for a bariatric surgeon for 6 years and many insurance companies wil respond to a second appeal. Don't give up. Go to your PCP and ask him to write a letter describing your struggles with weight. List all your diet attempts to the best of your knowledge along with a personal letter. If you have any other doctors ie orthopedic, GYN, LCSW etc have them write letters for you. In our practice my surgeon writes a detailed letter of need. If you receive another denial consider contacting a bariatric attorney. Walt Lindstrom, an attorney out of San Diego, has been working with bariatric patients for 7 years and he can tell you what steps to take if needed. Hang in there, it's so worth it! I had my surgery almost 8 years ago and it's improved my health and my life. The Best, Robin

The race is on! Since my denial I have been working on getting all the needed paperwork together to do the appeal. Luckily though, my surgeons office is doing the appeals letter and mailing it off. As of today, I think all of the paperwork is there If you do your own surgery... make sure you give yourself some goooood drugs!

Rebecca, this is extremely frustrating stuff! I know there used to be some rules for medical offices about releasing records that they have received from outside sources but for some reason I didn't think that was true any longer. You may want to call Patty Todd at OHSU Health Information Services department. She is a manager there and should be able to tell you if it is legally possible for them to give you the records they have from your previous providers. I don't have her number but if you call the general OHSU line at 503-494-8311, they should be able to transfer you. Tammy