I got this from Dena Listen up!!!!!

You will require documentation from your doctor that you have tried diets so if he has it in your charts that you are on diet. or that he has told you to diet that might work....this is the letter i got from Dena today:::::: Jan: Wow is right!  I'm glad you're fielding some of the questions, cause I'm swamped with questions too!  LOL!   Yes, however, it is not an "exercise" requirement, but it is a requirement for "documentation" from every patient that they have attempted to lose weight.   This was prompted by the ASBS convention, where in a Centers of Excellence meeting, Margie heard that Medicare is going to require this "documentation" as of July 1st.  We have not gotten the word from Medicare yet, but as with the ruling on Centers of Excellence, we don't get anything from Medicare until it changes.  We expect to get that new requirement for documentation on July 1st.  Other COE's have already cancelled patients for surgery who didn't have the documentation in anticipation of this... we haven't cancelled anyone yet, and I hope we don't have to.   I'm sending you a copy of the letter that I sent out so you know what it is.   Our patients have always had to have tried diets; I don't know of any patients who have said to me that they never tried to lose weight with diets before wanting to have weight loss surgery.  The difference is that we have always taken the patient's word for it and unless the insurance company required documentation of weight loss attempts, we have not required that documentation.  Now, since Medicare is wanting us to have that documentation, and the majority of our patients are covered by Medicare, we have just incorporated it as a requirement into our program.  That way, everyone could probably have the documentation of a physician's diet before they even come to an appointment   Thanks for your help Jan! Dena ************************************

June 25, 2007

 

 

To Whom It May Concern:

 

 

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 documentation 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 already 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.  (This information is from BCBS criteria.)

 

 

The other program 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 some 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 (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 documentation of 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

 

 

 

 

----- Original Message ----- From: Jan (Mimi) Cook To: Dena Neill, RN Sent: Wednesday, June 27, 2007 7:01 AM Dena I have been getting questions right and left about the letter you sent out to several people about the new 6 month exercise requirement that Dr. Hornbostel is now requiring? Wow!! Does it pertain to all patients? How about medicare recepiants? What about the ones that have already had their consultation and have a surgery date? just a few of the qquestions that are being ask of me i told them i dont know but would try and find out for them.   Jan

 

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Thank you Jan for getting us more information. Since my back surgery two years ago I haven’t done a conventional diet because I cant exercise. I did lose ten pounds back in January because I stopped drinking soda --- that may be noted in my medical record because my doctor did ask about it. But besides that I cant think of anything else that might be documented in my record. I’m going to call today and get an appointment to start a six month Dr. supervised diet ASAP. Jan do you think they could still scheduled my consultation appointment for six months out?  I have completed the rest of their requirements.

did you read that joining weigh****cher , which is probalby the cheapest route would be accepted along with notes from your doctor too. He will have to do certified documentation that you are on on the diet and your weight. Weigh****chers will be the cheapest way to go with the other part.

Dont know about them going ahead and scheduling your consulation. you can call and see what they will do. Lets hope so because they will have a huge flux of people 6 months from now too it would seem. Good luck sweetie. I enjoyed meeting you at the meeting the other night ment to get to you afterwards but didnt . Sorry. Hope to see you next month too. That will help keep you motivated toward your goal. If i can be of any other help let me know   love you.

Hey Jan-- GREAT NEWS!!!! I did what you suggested and called and spoke to Dena. They went ahead and scheduled my consulation appointment for October 24th!!!!!! Meanwhile I'll start my Dr. supervised diet. But at least I dont have to wait for my consulation appointment. This is the best news I heard all week!!! Unless my Dr. knows of a local diet program that is covered by Medicare I'll be going to weigh****chers. Thanks again Jan for getting more info about this new medicare change and hearing me out this morning-- you were a great help and comfort

Jan, I got that same letter from Dena and luckily I am on a 6 month dr. supervised diet already that will end on Oct. 6th.  I am glad that I started this in April and not just finding out about it now!  I hope surgeries aren't canceled due to this new requirement that isn't going to be fair to the patient that has already waited so long to go through the process.  I hope this new requirement doesn't discourage a lot of people?  I know that 6 mos. of a dr. supervised diet seems long and it does seem like it's going by pretty fast for me anyway.  I know Oct. will be here before I realize it then I will be on my way. 

Margie just called me and I don't know what to think. They want to move my surgery up to July 18th from August 3rd BUT they may have to cancel it on July 1st.  She said they just haven't heard anything and won't know till Monday.  I'm freaking out about maybe having the surgery sooner than I thought......and freaking at the idea that I might have to wait 6 more months.   My daughter and her family have planned their vacation around my surgery too...have booked their flights, reserved their hotel rooms and car and all that...so if I do have it the 18th she won't be able to be there.  She lives in Sedalia and is a health care professional so I really feel that I need her there with me at the hospital since neither of my sons will be able to be there. I don't know what to do.  Maybe going to the support meeting in Olathe tomorrow night will give me some insight.   You all have been GREAT!  I'm so glad I finally decided to get active here.  What a fellowship. Robin

your daughter will be on vacation on July 18th is that what you are saying? I dont know but i would go ahead and reschedual it. hoping that Medicare would allow any that are already scheduled anyway. Sometimes they will grandfather in things and others they wont.  You dont have anyone else that can be with you in the hospital when you have surgery?  Hopefully you will be like me and not really need anyone. lol I could have drove myself home i think if i had had to.  Hope all goes well for you.  Jan

I'm not sure exactly what dates they'll be gone but I know that she was trying to get it out of the way before my surgery.  I wish I'd written it down....I ALWAYS write stuff like that down.  She's in Dallas at a meeting and I can't get hold of her till later tonight and I think Margie would like an answer before she leaves this afternoon.   !!!!!argh!!!!! My oldest boy is working in New York this summer and can't come back and his wife can't miss work, and my youngest just started a new job and there's no way he could take off those days.  My sister could come up from Wichita but I had her do that when I had some gyn stuff done and she was less than helpful.  I ended up taking care of her after that surgery.   I really really want my daughter there.  I"ve read all the things that people have said about the nursing staff on the floor at Bothwell and I know them to be true.  My ex-husband is a nurse and he worked med-surg for 5 years at Bothwell and was always run ragged and unable to keep up with everything.  I want someone with me who's assertive just in case I'm unable to be.  I had 3 outpatient surgeries at Bothwell and think their surgical staff is wonderful.  It's the floor staff I'm worried about.    Anyone reading my posts might think I'm a big old bottle baby but I'm really not........just getting so angsty over all this.  I'm normally so calm and collected....the one who holds everyone else together when things fall apart.  I hate feeling this way! Thanks for letting me rant. Robin

Robin, Let them reschedule you.  If you wait and then Medicare changes the rules you'll never forgive your-self.  That will mean a six month wait that you didn't need to do.  Things will work out.  They always do and they work out in the most amazing ways.  Step out in faith and you'll be on the losers bench and if Medicare cancels you on July 1 it won't be because you didn't go for it!!! Hugs, Lana

sweetie i was at Bothwell for my surgery and i loved the nurses there. I got excelent care and anytime i rang my bell for anything there was someone right there at my door wanting to know if they could help me. I dont know why it was different for me than the people you have talked to but there were some excelent nurses and aides too when i had my surgery.  Maybe they were afraid i would take name and flame the on the OH board  lol . I dont know . I couldnt have had any better care than i had there. I have had surgeries in some big hospital and they were crap as far as i could tell compared to Bothwell. Jan