email from Dena(Dr. Hornbostel's)

Did anyone else get the email from Dena today about the new policy in their office beginning July 1?  Here it is.... As of July 1, 2007, we are adding a new requirement for our weight loss surgery (WLS) patients. Every patient will be required to provide documentation that he/she has been involved in a weight loss program for at least 6 consecutive months within the last two years. Most insurance companies are making the documentation a requirement for WLS coverage, and in fact, some insurance companies require documentation of two attempts at non-surgical weight loss before they will preauthorize weight loss surgery. In the past, we have accepted statements from the patient and physician of diet attempts without physician documentation. However, since the documentation requirement has become essentially a universal requirement, it becomes important for us to collect the information as early as possible in the WLS preauthorization process. We recommend that our patients start talking to the primary care physician and begin the weight loss attempt as soon as possible if they do not meet this requirement. Insurance requires documentation of the following in the physician???s records: 1. Dietitian or nutritionist consultation for low calorie diet 2. Increased physical activity 3. Behavioral modification 4. Pharmacologic therapy may be attempted in addition to the above requirements (this is not required, as it is not always an appropriate treatment) Documentation should include comments by the physician regarding patient progress or lack of progress. Monthly assessment and documentation of the assessment in the patient???s chart by the physician is usually adequate for the insurance company. Follow up with the dietitian or nutritionist is recommended. A letter from the physician without the documentation does not meet this requirement. Acceptable by most insurance companies with medical record documentation of medical supervision are: Weigh****chers, LA Weight Loss, Jenny Craig, The Diet Center, etc. (These are commercial programs that include diet, physical activity and behavioral modification within their programs.) Self-directed diets such as Atkins, South Beach Diet, etc., are not acceptable by most insurance companies. The other requirements remain the same: 1. Attendance at a seminar held by Dr. Phillip Hornbostel 2. Psychological clearance by a psychologist or psychiatrist, including MMPI if the patient is on Medicare 3. Returning the requested paperwork to the office (copy of insurance card, returning the form received at the seminar, and entering the information requested into the ???sedalia.remedymd.com??? web site) We recognize that many of our patients and their physicians will be unhappy with this new program requirement. However, it has always been a requirement for a person to attempt non-surgical weight loss before turning to surgery for weight loss. We have not had to require the physician documentation in the past for everyone as we have taken the word of the patient and the Primary Care Physician that weight loss attempts have been made. Now that it has become an insurance requirement to show physician ???supervision??? of weight loss attempts, we feel that we must require this documentation as well, so the information is available to submit to the insurance company. Thank you for your cooperation in this matter! Sincerely, Dena Neill, RN Bariatric Nurse Coordinator I emailed her back and asked her about those of us that are already in the process  of approval and I am waiting to hear back from her.Talk about an emotional rollercoaster.  Layla

Yea I hope that they dont require this for current clients. That would be very frusterating for you.  But I think this may be a good idea for new clients so they know that striaght up in stead of a month latter when they find out from insurance. Best wishes!

I didn't get the email....I wonder if that's because I'm a Medicare subscriber?

I got the email too. I emailed Dena back asking if this applied to Medicare patients as well--- but it probably well. It’s so frustrating because just today after FIVE weeks my physiological testing/clearance was completed and faxed to their office. Everything else was completed and I was told Medicare didn’t require a pre approval so now I was just waiting for a consultation appointment. I guess I may have to wait till next year : (

Thats Dr. H's requirements  he wants it......doesnt have anything to do with insurance now. Good luck to all of you waiting for surgery and my prayers are with you all. ricki