Question:
How to document???
I have been denied for the second time. I have done the six month Dr Supervised blah..blah..blah...but Aetna is denying me for the second time. I need to know exactly how to document the diet. I am about out of my mind, as I thought I had crossed every "t" and dotted every "i". Thanks for your help. — Yvonne R. (posted on December 16, 2003)
December 16, 2003
how did you exactly do your dr supervised diet?? did you weigh in every
month?? did you lose at least some weight?? did your dr document every time
you weighed in about your weight loss and your exercise regimen?? and if
not able to exercise did your dr explain why? I also am on the 6mo diet for
Aetna ppo and will be done on Jan 04 I am so excited..email me if you want
to hear what I have done.
— por2geegurl
December 16, 2003
You need to find out EXACTLY why you were denied...what you supposedly did
wrong or didn't get to them. Sometimes it can be as simple as a piece of
paper that the doc didn't get submitted. Bug them to find out - you have a
right to know!
— [Deactivated Member]
December 16, 2003
Are you sure it's the Dr. assisted diet that is getting you denied? The
key is an iron clad Drs. letter. He has to make note of the weight you
started at when you began seeing him and your current weight. He has to
also note that you've tried several weight loss programs unsuccessfully.
You also have to make sure they document any co-morbidities. I have
chronic asthma so that was listed on my letter. I have Aetna HMO and my
letter didn't make mention at all that I had tried Dr. assisted weight
loss. I was approved after my first request about two and a half weeks
after the surgeons office made the request. Good Luck, I'll be praying for
you.
— Niobe
December 16, 2003
Did your PCP (not your surgeon) document your periodic weigh-ins? Did your
PCP send your actual medical records with those notes to the insurance
company (required for approval)? Did you also have a consultation with a
nutritionist and have that documented in your PCP's records (take a copy of
dietician/nutritionist notes to PCP for him to add to your file)? Did your
PCP also set you up on an exercise regimen that he documented in your
medical records? What about the Psychologist consultation? All of this is
required by Aetna and it must be in your medical records - not just in a
letter. If you read Aetna's requirements
http://www.aetna.com/cpb/data/CPBA0157.html
you can see that a Dr.'s letter is not sufficient. They require copies of
the actual medical records with everything noted in those records.
I have Aetna and I didn't trust my surgeons office to take care of these
details themselves, so I obtained copies of all of my medical records (from
PCP, OB-GYN, etc.) and went through and hi-lited the important information
such as where he noted that I was attending Weight Watchers, that I was
doing a low-cal diet, etc. I also had copies of my nutritionist records
(from 3 visits) plus a copy from my local YMCA where I met with a personal
trainer one time to set up an exercise regimen. I sent this all to Aetna
myself along with a letter where I addressed every one of their
requirements individually and how I met them.(and copies to my surgeons
office) and was approved within 2 weeks.
Just relax, regroup and take a good look at all of their requirements and
make sure you have met them. If you feel you have met them, find out
EXACTLY why you were denied.
If there's any way I can help you, I'd be happy to. I can e-mail you the
letter I sent them if you'd like (some of their requirements have changed
so the letter would have to be changed a little).
Good Luck and please feel free to contact me if I can help.
— Carolyn M.
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