Question:
What else can I do?
I go for my initial consult next Monday the 12th. And meet with my PCP on the 13th for his referral letter. I've got the following items: 1. PCP letter (hopefully) 2. Letter from chiropractor re: back pain 3. Letter from OptiFast program documenting enrollment 4. Medical history showing use of Xenical, Fen-Phen and Meridia 5. List of doctors with phone numbers, addresses, diagnosis and meds prescribed 6. Typed up diet history showing program and year I was on it. I really don't know how much I lost and gained back. Does that matter? My question is this: what more can I get together to help my approval process? I have Aetna insurance. I'm hoping to get my surgery in by the end of the year, so I'm looking to have everything ready for them from the get go. Anything you can recommend will be appreciated. Thanks!!! — Kathy B. (posted on November 5, 2001)
November 5, 2001
Sounds good to me. Do you have anyproof of past membership to a gym?
— [Anonymous]
November 5, 2001
I'm in the pre-op stage also. I have a surgery time in January, but it's
not secured yet because my doctor just recieved priveleges at my local
hospital. I started the process in May, 01. My surgeon questioned me for
all my past history and that was what was sent to the insurance. Sounds
like you have most of the information needed. Once you start going through
the testing those reports will indicate all your diagnoses needed to be
covered by insurance. One of the tough questions for me was my family
history and obesity. The questionaire my surgeon give me went back 2
generations with aunts, uncles, grandparents and parents and siblings. A
lot of my relatives I didn't know personally because they lived in Wa State
and I grew up in Oregon, but I questioned a brother who knows a lot about
our family history.
But all that information was given to the insurance company by my surgeon.
The insurance questioned all the diets I have tried, but didn't question
specific dates. I told them I lost the weight but gained it all back and
then some by the end of a year.
Hope that helps. Don't stress about it all at once....pieces fall into
place. Good Luck!!!
— Jeannette C.
November 5, 2001
Your list looks great! My surgeon also wanted to know what previous
surgeries I had completed and their dates, family history of comorbidities,
and a list of current medications and dosages. Hope this helps.
— Paulette W.
November 5, 2001
Wow, sounds like you have it together! Congrads! If you have copies of
your medical records, you may be able to loosely figure out how much you
lost and gained back with your diet attempts. I "guessed" with
almost all of them and it really looked more together, I thought. Also,
you may want to write them a letter from you. I wrote them a letter with a
synopsis of what I had included, how the weight affected my health and how
it affected me mentally. I also told them how much research I had done and
that I understood the expected outcomes and risks of the surgery. I had
Aetna too. They approved me in 4 business days. It was great. But I have
friend who had to wait over a month for her denial. Aetna approves a LOT
and it sounds like you definitely have the criteria met. GOOD LUCK! PS.
Aetna also automatically approves prophylactic gallbladder removal w/WLS
due to the high incidence of us losing ours post op. My surgeon
didn't...and I had to have Open (due to WLS scar) gallbladder removal at 6
mos post op. I recommend they removed it if you can get them to ;) Happy
Losing!
— Nicole P.
November 5, 2001
PICTURES! If they see a picture of you they can relate better,you are not
just a # anymore.(make sure it is one that makes you look the biggest..lol)
Also, write them a letter from you asking for the approval, give them an
idea of you and how obesity effects your life.
GOOD LUCK!
— [Anonymous]
November 6, 2001
You are one organized lady! I think you've covered all bases.
Don't bother with pictures. I work in this field and the reviewer
is interested in clinical documentation. The insurer isn't interessted
in how you "feel", your low "self-esteem" or pictures.
State the "facts"
and "nothing but the facts".
— [Anonymous]
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