5 yr medical history?

crystal220
on 3/23/09 1:00 pm, edited 4/1/09 4:38 am

What happens if you are contacting the past physicians you have seen over a period of five years and due to them no longer working in private practice and them not responding to your calls and emails in result I am unable to obtain a full five year medical history/records as the insurance require? How long are the docs suppose to have the patient records? Where do the medical records go after their practice have closed down?

Doctors office is no longer open  and the other has relocated...what now? Any suggestions and/or experience to share.

                                              
                                                          ~NEVER SAY NEVER~

    
Arkin10
on 3/23/09 1:41 pm - TX
I am currently battling for approval with BCBS too.  I was denied right off even though I met all of the criteria required by the Medical Policy on my plan.  I just received a letter from them today saying they are reviewing my appeal & it could be as much as 60 days before a determination is made.  Welcome to WLS approval hell.  Next to the difficult, life-changing decision we make to become healthier people, we have to go thru a multitude of insurance hoops to get there.  Some of us more than others.  As I understand it from the past 8+ months I've been reading this site, BCBS is notorious for automatic denials.  That said you DO have a real problem if your plan's medical policy requires 5 years of medical records and you don't have them.  Your past doctors are required by law to release your records if you make the request in writing.  Usually your surgeon's office has this form and will fax it for you even.  At least mine did. 

You need to go to your insurance company's website and read it (copy it down is best) and see exactly what it says the qualifying requirements for WLS are.  For example, my plan is BCBS of Illinois, a PPO plan and my employer does not have separate rules for WLS than that of BCBS's criteria.  Some employers do so you need to ensure yours doesn't either or if they do, what the employer's qualifications for WLS are.  My plan required 5-years of weight history.  Not 5-yrs of medical history.  And it didn't say it had to be 5 consecutive years either.  I had about a 10 yr gap in my medical records because I was healthier back then and the one doc I did see, my GYN, I couldn't get a response from because he had retired.  Trust me you will have to work as hard at getting approval as you will at learning and preparing for a new lifestyle.  It's hard but it can be done as countless hundreds of other folks here at OH have proven.  We just have to fight our way up through that darned insurance line to get what we deserve.  Good luck to you and keep posting your questions.  I have gotten so much help here, including info on filing my appeal.
crystal220
on 3/23/09 1:59 pm

Wow!!! I am so sorry to hear of your recent insurance denial. Yes, this has been a bit of a roller coaster. However, just as you stated, there a lots of people here on OH who has/is offer help in this process. Another OH member just told me she too went through the same request with BCBS and told them that she didnt go to the doctors regularly unless she was drastically ill due to non insurance and she was eventually approved. I know each case is different and has it's own specialty of concerns and issues but I would say to you, myself and others in the process. Stay strong, fight it all the way, do not accept "NO". Thank you so much for all your information and knowledge that you've given me.

Also, it is weight history they are asking for not necessarily medical records.

Good luck and keep me posted on your progress.

                                              
                                                          ~NEVER SAY NEVER~

    
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