Question:
WHAT DETAILS ARE IN A DIET HISTORY?? PLEASE HELP!!!!!!!!
MY PCP HAD NO CLUE WHAT TO PUT IN THE LETTER OF MEDICAL NECESSITY, I'VE ONLY SEEN HIM ONCE BECAUSE I MOVED TO MD FROM FL. HE IS NICE, BUT CLUELESS... I NEED THIS SURGERY BUT I HAVE NO CLUE WHERE TO BEGIN. I HAVE PLENTY OF DIET HISTORY BUT WHAT ARE THEY (INSURANCE) LOOKING FOR? — CHIYNA29 (posted on November 9, 2007)
November 9, 2007
Every insurance company is a little different in what guidelines they use
to determine eligibility for surgery. I used to work in prior
authorization for states sponsored buisness and so I reviewed charts for
medical necessity for patients who were seeking bariatric surgery. The
main things that the insurance company is looking for is first, that your
BMI is 40 or greater unless you have other health conditions. If you have
other conditions than they will consider you as a candidate with a lower
BMI if it is determined that these other co-morbitiies would be lessened by
the weight loss. Some of those conditions include asthma, hypertension
requiring medication, diabetes requiring medication, orthopeadic issues,
and sleep apnea requiring the use of CPAP or BiPap. So, if you have any of
these conditions and see other doctors for them you will need to get those
medical records to support it. Although diet history is very important,
you must show that you have had a certain amount of time, and if varies by
company, or physician assisted weight loss, not that you have just tried
weight watchers etc for some many year. So, again, if you have been on
medication for weight loss or seen a dietician for weight loss, those
records would be important to have. Any medical records with information
regarding conditions that are worsened by exessive weight is helpfull. Do
not be afriad to send them lots of records. The more you can send to
substantiate the need, the better. They will weed out what they don't need.
I would recommend that you call your insurance company and ask them to
send you the guidelines they use to determine eligibility for bariatric
surgery. They should either be able to send you something or tell you
what you will need and that will give you and your doctor a place to start.
Also, one thing to keep in mind is that experienced bariatric surgeons
should know what information you need to get approved and there office
should be able to help you with what you need. If they do not know this
information, I would be sure to double check thier credentials and
experience with this type of surgery. Good Luck to you and I hope this
helps
— Kristi.mccloud8033
November 9, 2007
When I had to fill out a diet history, it was how many diets I had tried
over the years. Nutri system, Adkins, etc. Is that maybe what they are
looking for?
— Carlyn M.
November 9, 2007
Remember to make copies of all materials you send insurance. my blue cross
"lost" some of mine on several occasions in the 17 months i
worked with them. Start a big folder and just stuff all copies into it and
save them.
— shalmar
November 9, 2007
Where are you having your surgery? I had mine at Barix Clinic and at my
consultation they gave me a packet and in that packet was a DRAFTED letter
stating what was needed in order to get my surgery approved. I actually
gave that letter to my doctor as a guideline. It worked. 6 months later
I'm down 80lbs. Good luck.
— Suzanne B.
November 9, 2007
They are looking for "medically necessary" to be in the letter.
I wrote my letter myself and told my PCP he was free to use it. I think he
was relieved. See if your weight loss surgeon has a sample you could use
as a model. Good luck- Marlayna
— MWiley
November 9, 2007
My insurane required a six month physician supervised diet. During this
time I basically maintained my weight. All of my previous diet attempts
needed to be listed in the letter along iwith my medical conditions
indicating the need for surgery. My insurance also required submission of
five year of my medical records. My PCP wasn't sure about the letter so I
composed it myself and he approved the letter. His staff typed it on their
letter head and he signed it. They gave me the letter a a copy of five
years of my records. I submitted them to my surgeron to forwarded them to
the insurance company and I was approved within a week. I had my RNY on
10/22. Every insurance is different but this is what I had to do. You may
try to find a person who has had the surgery and see if they still have a
copy of the letter they had from their PCP and use that for a reference. I
hope this helps you.
— t_roxus
November 10, 2007
HI, I JUST GOT HOME ABOUT 2 HOURS AGO FROM HAVING MY GASTRIC BYPASS
SURGERY, MY SURGEONS OFFICE GAVE ME A LETTER FOR MY PCP TO COPY AND THAT'S
WHAT HE SENT IN TO MY INSURANCE, YOU MIGHT WANT TO ASK YOUR SURGEON ABOUT
THIS. HOPE THIS HELPS!! GOD BLESS, DEBI ROBINSON
— DEBI R.
November 10, 2007
Your surgeon could be doing what he can to get you on the right road, which
I do hope you find will be do able. I have a feeling that you are doing the
same the samething to your self that I did I to myself. No matter what
anhone told me I did what I darned well chose because I didn't want to lose
my family and ultimately this gastric byss.
— EmtEeyore
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