My DH's PCP messed up the Documentation of the Medically Supv Weight Loss

My husband's insurance requires a 6 month medically supervised weight loss attempt. We knew that and he started it last November. We applied to the program at Duke. Got all of the preliminary testing done while he was doing the medically supervised diet. Scheduled his appointment to see the folks at Duke. Had all of the medical records sent over and to our amazement and disappointment, the clinical notes submitted by our PCP failed to adequately document the medically supervised weight loss attempt. UGHHHH!!!!!!! I used the same practice for my own surgery with the same insurance, so my husband reasonable expected that they knew what was required; apparently not. So here he is, doing it all over again. It looks like some of the medical testing that was done in prep for submission to insurance will have to be redone because it will age out. While the RNP that has been seeing him is sorry and wrote a letter indicating that she had been seeing my husband and what they had discussed, it doesn't matter because she didn't get the right details into the clincal notes.

If you need to have a medically supervised weight loss attempt, be sure to check with your insurer to find out exactly what they want to see in the clinical notes and then communicate that information to your health care provider. My husband's insurance requires:

vital signs, ... i.e., weight, blood pressure, etc...

discussion of weight loss program being attempted ... i.e., portion control, logging of foods, weight loss meds., high protien/low carb diet, etc...

discussion of exercise program being attempted ... i.e., walking 30 mins 3 x week, resistance training 30 mins 3 x week, etc...

discussion of behavior modificatons being attempted ... i.e., counseling sessions, attending support group meetings, working through a behavior modification program, etc...

results of attempt ... i.e., loss, maintained, gained X lbs.

I hope that if you require a documented weight loss attempt you will find out not only what the insurer wants but what is being documented at each visit so that you can avoid the disappointing and costly mistake we are dealing with now. Now we are getting a copy of each month's clinical notes. They are being submitted to our program for review so that if there is a problem it will be caught early on.

My DH is a real trooper and while he's really terribly disappointed, he's putting one foot in front of the other and working to make the best of a difficult situation. I hope that telling you of his difficulties might help someone else avoid the emotional and financial expense he is experiencing.

Barb

I was told it was better to have the PCP give you a referral to the WLS surgeon to have the diet supervised by them because they are accutely aware of what exactly needs to be documented!

Thanks for the suggestion.

B

Unfortunately that's not true for every insurance though.  I thought I was safe doing my supervised diet through my surgeons office and was told after 3 months that it HAD to be done with my primary care provider, not with a nutritionist or my surgeon.  Who would have guessed that?  Know I have 3 more months to go.  My PCP too did not have adequate notes but I was fortunate enought that my insurance would accept an addendum to her clinical notes.  I know how your hubby feels though, it's like they want you to stay fatter longer.  I've had to reschedule my surgery twice already.

Hello-
My insurance got denied because my PCP didn't have enough documentation.  What exactly are they looking for?  Can you tell me?  How did she do the addemendum?  I am just very upset because I had everything else ready to go and thought that they had suffient documentation.  any input you can give me would be great!!!  Thanks so much and hope you are doing well.
Kim

Hi Kim,

Contact your insurer and ask them to let you know specifically what they are looking for in the clinical notes. They will tell you and you can provide that detailed information to the Dr to ensure that they are providing the appropriate information.

Barb

When you say that they accepted an addendum to the notes, can you let me know more about that. My PCP wrote a letter that was an overview that said that she saw my husband and that they indeed discussed diet, exercise, etc at each visit, but honestly it wasn't detailed enough. Was the addendum a letter or was it an addendum to each clinical visit notation? You said that you were told after 3 months that it had to be done with your PCP ... Were her original notes insufficient? How did you find out they were insufficient? And when?

Please forgive the barage of questions.

Thanks in advance,

Barb

No forgiveness needed, we all come to a point where we have our barage of questions.  Anyway as far as the first three months it wasn't for lack of insufficient notes, it was because the surgeon was having me see a nutritionist and my insurance would not accept those visits, it needs to be with my primary care doc.
Secondly, after my last three visits with my pcp she sent over the clinical notes and they were "weak".  Instead of having to do everything over I was told that if she included an addendum with my notes that depending on what she wrote, that might be okay.  She made an addendum to the notes to say that at my first visit and "each subsequent visit" that we discussed my weight, that I would be watching my calorie intake and trying a low-fat diet.  She also said that I would continue my walking and then listed things that were bothering me such as my feet, back etc.  Because she did this as an addendum to each visit they said that is was acceptable.
I hope that helps.  Very rarely can a physician go back and add or delete to their clinical notes.  Anything discussed in a visit that is left out of the notes has to be added as an addendum with their signature.
Any other questions let me know.

Hi Louise,

Thanks for the information. I'll try running this by my PCP to see if they can and will do this and if it would suffice. It wouldn't hurt to try.

Thanks again,

Barb

Thanks for the information.  I'm going to make sure they note these things in my chart each time. 

I just started my 6 month diet.  I'm keeping detailed records of what I eat and when I exercise using www.thedailyplate.com     At the end of the week, I print my weekly totals and put them into a folder.  I will take them with me to my monthly appointments and include them in my dr's chart to show my progress.