XP: Revision, Insurance and Food Log
I am pursuing an RNY to DS with Dr. K in California. Just finishing up the food log, and then the Glendale office will be submitting into insurance. We are shooting for a date before the end of the year, providing that I am approved.
My question: Just wondering WHY does insurance want a food log? What do they possibly gain from looking through it?
Yes, I am pursuing a revision, but, HONESTLY, I really think this is just another "hoop" and that the insurance company just literally hopes that I give up already!!??
Anybody "versed" in the insurance please reply!!! And, of course, any and all insight is helpful!!
*****************This is posted in my blog, received October 2009**********************
We forwarded you request to preauthorize revisional bariatric surgery for Jamie (Last Name)to the medical consultant for the Alaska United Food and Commercial Workers for an individual review.
After completing the review, the consultant has informed us that the submitted documentation does not support that revisional bariatric surgery is medically necessary for this patient at this time. The consultant indicated that "There needs to be a through dietary log to assess the possible role of poor food choices and dumping syndrome in this patient with weight gain. Additionally, this patient should be evaluated with upper endoscopy and/or contrast upper GI study to assess for a specific anatomic abnormality following a previous gastric bypass."
Since the proposed surgery was determined by the reviewer to not be medically necessary at this time, we will not be able to provide reimbursement toward the proposed surgery.
Please let me know if you have any questions, or if I can be of further assistance.
(Claims Operator Name)
NO WHERE does it say the length of time for the food log. So, I did call the insurance company, and she pulled "6 months" out of her hat, and gave that to me as a time frame needed for the food log.
Thank YOU!!!!
-Jamie in Alaska
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
WHEN LIFE KNOCKS YOU DOWN TO YOUR knees, JUST REMEMBER THAT YOU ARE IN THE PERFECT POSITION TO PRAY. HW 395, RNY 4/2/07 345, Lowest Weight 248, Revision to Distal RNY 1/13/09 278,Revision to DS 10/15/10Thank You, Monique!!! I know that we all need to fight for what we want, but, these stall tactics and hoops are just plain PAINFUL!!! But, I will not give up!!!
I had the upper GI, and the EGD, but the results with the EGD were ridicilious, to say the least about the danm doctor who performed it. But, I was successful with weight loss, it just did not stay gone, is all.
Thaks for the insight and encouragement chickie!!!
-Jamie
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
TT 4/9/2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
