Question:
is there any point in filing for surgery w/bc if no
is there any point in going through h**l to get all this info together and get excited about surgery, only to have it denied? dr. rutledge requests all this info, but i don't have a pcp. mine died 2 yrs ago, no copies of my records could be found.i have no detailed diet history. i'm ready to just give up. i can't even meet the surgeons requirements about the paper work. my bmi is 48 and will be dead soon, probably. i need some help with this. any md out there i could go to for a letter of med necessity and them be my pcp?? i live in north alabama. please help!!!! — elizabeth C. (posted on May 30, 2000)
May 30, 2000
Find a bariatric center in your area. They will help you in whatever you
need. As far as diet history I made a list of what I tried and that
satisfied my ins company. You need to get in touch with a doctor in your
network. Who do you see when you are sick. Start with your office there.
Make your own diet list and approximate dates
— snicklefritz
May 30, 2000
I do not have BC, I have Prudential POS..but all I did was turn in a
written list to my surgeon of all my weight loss attempts and how much I
lost and how much I gained back. and that was plenty. I never provided
records, nor did my PCP, I dont believe. good luck!!
— Kim B.
May 30, 2000
Elizabeth, I have BCBS Federal and all I had to do was show my surgeon a
list of what I did also. Did not have to provide records. Hope that helps
:-)
— Alicia B.
May 30, 2000
Hi Elizabeth,
I can certainly understand your frustration with this huge mess in trying
to get insurance to pay for surgery. First of all, if your PCP died then
another doctor should have taken over his patient load. If not, then you
should be able to go to the hospital that he was affliated with to request
your medical records. By law, someone has to have those records SOMEWHERE.
They cannot just disappear with the doctor. I would check the local
hospital or hospitals to find out if they have any information as to who
may have taken over those records or where they may be stored. Someone has
to know something. Second, I would find a PCP in your network and begin
working with him/her. This way, you will begin to have a history of trying
to lose weight with another PCP and it will be documented. Most surgeons
will require that you have a PCP anyway for follow up care. I know Dr.
Rutledge does, by mere fact that most of his patients are from out of town
and he can't follow up with them personally. So, I would begin searching
for a PCP as soon as possible. I know that all I had to do for my
insurance company was make a list of my "diet attempts" and their
outcomes. And that satisfied them, they approved it rather quickly. You
could also call your insurance company and find out what they will require
from you in order for them to approve the surgery. Most times the surgeon
requires way more information than the insurance company because they want
to get the best chance of getting you approved. And having as much
personal information and history from you the better, including the diet
history. If you need any help I will be more than willing to give you a
hand in any way that I can. Although, I live in Virginia, I will try to do
what I can from here. Everyone goes through this and it's a tough road to
travel, and yes going through the hell to get the surgery is well worth it.
Please don't give up, it will all work out for the best in the end.
Please feel free to email me if you would like any help. Good Luck...
— Marni
May 30, 2000
I am sorry to hear that you are having this difficulty. I doubt, however,
that you have to secure your medical records to document your weight
loss attempts. Sit down with a pad of paper and a pencil and
begin to list every diet that you can remember being on, whether
they were through an organized group (Weight Watchers, etc), or
physician supervised, or just on your own. Also include exercise
programs that you went on to lose weight (like joining a gym). If you
have trouble remembering, ask family members and friends. Try to remember
when you were on the diet, how long, how much you lost and how long
you kept it off. This is generally all that the insurance company needs
- a thorough list that shows that diets have failed you. And don't
worry about being perfect. If the insurance carrier needs more
detail, it will ask for it.
Good luck to you --
— Kathleen B.
May 30, 2000
I was approved by a small group Blue Cross PPO plan in California. The
clinic sent me a long list of Blue Cross paper work demands, which BC never
in the end even asked for. Blue Cross approved me with just the letter of
medical nessesity from my surgeon (within a week). By the way, I had no
documented medically supervised weight loss. So give it a try, you never
know. You just may get approval without having to jump through any hoops.
— Jilda H.
May 30, 2000
I have a PPO (no PCP referral required), but my plan wanted to see my wl
history. I typed up a list of all the diets I had been on and handed it to
my surgeon with his required paperwork. He was impressed that I took the
time to document everything and wrote a great letter to the insurance
company. I was approved in less than two weeks. Just make sure you write
everything down, i.e., Weight Watchers 3/99 to 6/99, beginning weight 275#,
pounds lost - 23, Jenny Craig 9/99 to 2/2000, begining weight 285, pounds
lost - 10, etc. I hope this helps.
— heidiinPA
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