My DH's PCP messed up the Documentation of the Medically Supv Weight Loss xpost

My husband's insurance requires a 6 month medically supervised weight loss attempt. We knew that and he started it last November. We applied to the program at Duke. Got all of the preliminary testing done while he was doing the medically supervised diet. Scheduled his appointment to see the folks at Duke. Had all of the medical records sent over and to our amazement and disappointment, the clinical notes submitted by our PCP failed to adequately document the medically supervised weight loss attempt. UGHHHH!!!!!!! I used the same practice for my own surgery with the same insurance, so my husband reasonable expected that they knew what was required; apparently not. So here he is, doing it all over again. It looks like some of the medical testing that was done in prep for submission to insurance will have to be redone because it will age out. While the RNP that has been seeing him is sorry and wrote a letter indicating that she had been seeing my husband and what they had discussed, it doesn't matter because she didn't get the right details into the clincal notes.

If you need to have a medically supervised weight loss attempt, be sure to check with your insurer to find out exactly what they want to see in the clinical notes and then communicate that information to your health care provider. My husband's insurance requires:

vital signs, ... i.e., weight, blood pressure, etc...

discussion of weight loss program being attempted ... i.e., portion control, logging of foods, weight loss meds., high protien/low carb diet, etc...

discussion of exercise program being attempted ... i.e., walking 30 mins 3 x week, resistance training 30 mins 3 x week, etc...

discussion of behavior modificatons being attempted ... i.e., counseling sessions, attending support group meetings, working through a behavior modification program, etc...

results of attempt ... i.e., loss, maintained, gained X lbs.

I hope that if you require a documented weight loss attempt you will find out not only what the insurer wants but what is being documented at each visit so that you can avoid the disappointing and costly mistake we are dealing with now. Now we are getting a copy of each month's clinical notes. They are being submitted to our program for review so that if there is a problem it will be caught early on.

My DH is a real trooper and while he's really terribly disappointed, he's putting one foot in front of the other and working to make the best of a difficult situation. I hope that telling you of his difficulties might help someone else avoid the emotional and financial expense he is experiencing.

Barb

Oh My Barb,
Just another road block the insurance likes to put in front of us.
I dont understand why things like this happen and not to mention all the hoops people have to jump through for wls.
Tell Ben I said hang in there,there will be light at the end of the tunnel.
                                             Annie

Hi Annie,

I shared your note with Ben and he said to tell you he appreciates your support... So do I!

Barb

P.S. I should clarify that this wasn't really an insurance company throwing up a roadblock as much as it was a screw up on the part of our PCP's office.

What a pain and disappointment!  Glad that he is keeping his spirits up about it all.   Hopefully, this next trip around, things will get smoother.

Good luck and take care,

Pam

Hi Pam,

You are so right ... it is disappointment and pain in the you know what, but hopefully, he'll sail through eventually.

Barb

Oh gosh, how disheartening.    I bet you are so proud of your hubby's fortitude.  He has obviously seen, first hand, that his efforst are going to be greatly rewarded! 

Hi Shauna,

Thanks for the words of support. You are right, Ben actually started looking into WLS before I had my surgery. Immediately afterwards, he said he was glad I went first because there was no way he'd do that ... fast forward 6 months and he was starting the process. I know that this is difficult for him, but he and I believe that it will come through eventually and in the meantime he is working on making some healthy lifestyle changes.

Thanks again for the support,

Barb

Oh no, Barb! I was so hoping this would not happen... Praying for you and Ben as you work through yet another hoop.  Kudos to Ben for not letting this get him down!!!

((((((((((((((((((((((((((((((((((((((Barb and Ben)))))))))))))))))))))))))))))))))))))

Melinda,

Thank you so much for your kindess and support. We both appreciate it. While we both were distressed and disheartened by the news, we also firmly believe that he will 'get there' ... What is that they say ... If you want to hear God laugh, make plans ... I know that this will happen in the time it is supposed to happen. In the meantime, we will continue to work on ensuring that the following appointments are properly documented and that we have all of our proverbrial ducks in a row, so that when he's completed the second round of medically supervised weight lost attempts we can proceed. I'm sure that while we can't see the forest for the trees now, there is a reason for this. I also know that while we are impatient once we have decided that we want to 'get our lives back,' that the few months we spend working on getting the approval to move forward is a drop in the bucket relative to the time we have spent in the condition that causes us to seek WLS and even better, hopefully, it will only be a drop in the bucket relative to the time he will have living a healthier life after WLS. In the meantime, he's working on living a healthier life now as he works towards what I know will be a life-changing event for him.

Thank you again so very much for your warmth and support.

All the best,

Barb

This is exactly the reason I've decided not to have bariactric surgery.

I jumped through all of Duke's hoops including going thru more than your average number of extra tests because of the kidney failure.

After submitting all of my evaluations, 6 months medically supervised weight loss attempts whi*****luded the diet my doctor put me on, DETAILED (3 page) monthly lab reports, weekly evaluations from a doctor and monthly evals from a RENAL dietician, treatment reports for each treatment (3 times a week) whi*****luded blood sugars, blood pressures, weights, and temps plus more, the people at Duke had the audacity to tell me it had to be a program like Weigh****chers or Jenny Craig. Well, F*** them.

I don't think for one minute that the insurance would require another 6 months of weight loss failure, especially from someone like me who has renal diet resrictions that Weigh****chers (WW) and Jenny Craig can't address. It's completely retarded for me to go from having a diet planned specifically for me to WW just because the Duke people don't want it to be "in-house." (their words) I think they want me to do 6 MORE MONTHS so they can require all the absurd testing to be done over again. I also think they assume I'm getting my testing done thru them (Durham Regional Specialty Services) and are completely milking the Medicare cow.

DUKE sucks.

Kelly