TravelDiva

Send Message

Block

Add Friend

Ok - Latest update.  It's been awhile so I'll make a long story short.  Like I said in my prior post, My former PCP would not go back and send supplemental letters to my insurance company.  He said it was too long ago and the notes he had were the only ones that he had.  Sooooo...Being that the insurance company denied my paperwork 3 times,  because the reps kept sending the same documents to the medical review board, I decided that I was going to do this 6 month stint again. I called my surgeon's office and asked them for a recommendation for another PCP who was versed in detailing my office visits for the 6 month supervised diet.  I made an appointment from their recommendation and today I had my first meeting with him.  I have to say today was the first day since I decided to fight back that I felt positive about starting over.  Many WLS patients have gone to my doctor for insurance required supervised diets.  He is very knowledgable in what they are looking for and when I told him that I was denied 3 times he told me that I won't be denied a fourth time and for me not to worry they will take care of me.  I was so happy that I started to get emotional from the relief I felt.  Needless to say he is now also my PCP.  I loved his and his staff's bedside manner and the support that it looks like I will finally get.  So, yes I am starting over but not really because I know that my time is not God's time and when he is ready for this surgery to take place that is when it will happen.  Bye for now.

Blessings,
Glynda 

Ok, Well the last time I posted it was August.  Time goes by so fast.  I needed to take a break from this journey.  I nearly gave up. Long story short - I called my PCP and asked for him to document in detail my 6month medically supervised diet.  His nurse told me that he couldn't do it because one it was so long ago and two he says that he didn't see me for the whole 6months.  Duh. No but 2 other doctors in his group did see me and they documented my visits.  So, I called my surgeon's office and asked for a recommendation to a PCP who is versed in the requirements of insurance companies.  They gave me a doctor who I will call and start this 6 months all over again.  They were very encouraging and told me not to give up (which is where I was mentally).  They told me that this is what the insurance companies want, they bank on people getting discouraged.  So here i go again.  It just seems that everything,  and I do mean everything is a fight.  Well i will not compromise my health any longer and I am ready to fight again. Please pray for me.

Blessings

Hey OH,
Like I said I would be blogging often because I need to keep notes for myself.  My memory is hazardous so this is a great way for me to document my journey.

Okay well today I called BCBS of IL because I figured they had plenty of time to receive the faxed copies of the months they were missing. My surgeons' office sent them to two different fax numbers on Monday 8/27.  I was told that they did receive it and the medical board reviewed and denied it again.  Again, the c/s rep didn't understand why.  I asked her just exactly what are they looking for?  Are they sugguesting that I do that stupid 6 month supervised diet again?  She said no, but they are looking for specific notes from the doctor visits.  Apparently my doctor didn't write weight goals, caloric intake, exercise goals and portion control.  I asked her why aren't these specific requirements included in their coded descripton for gastric bypass surgery.  Of course she couldn't tell me.  I would have had all of this taken care of before they submitted the first time.  

Tomorrow I am going to call Gary Viscio (lawyer on the insurance forum)  and ask for his advice before we turn in another submittal.  BCBS of IL said my doctor could write a supplemental letter with those added requirements but it had to include every month of the 6month diet. So I just want to get some insight before I ask my doctor to do this.  The BCBS of IL c/s rep said that she was going to send it back through to the review board because she couldn't figure out why it was denied again since it looked to her like all the requirements were there.  Go figure. We'll see how it goes tomorrow.

Blessings

Hey OH,
Well today I called my surgeon's office and left a message for them to call me. I went on to say what the insurance company was missing from my submittal, (which were the first two of the 6 month supervised diet) but for her to please call me before she faxed it to them.  She left me a message a little later saying she already faxed what they needed. (It must be me).
I called her back and said that,  like I said on the message I wanted to talk to her before she faxed the info again because I wanted to make sure she wasn't sending them something they already had. 

So she assured me that the pages she faxed were in fact notes that they were missing and sometimes when you send a bunch of pages at one time things can go missing. I agreed since that happens all the time at my job.  I also gave her the fax number the insurance company gave me.  I told her that I would feel better if she sent it to that number as well so I won't hear 2days from now they never got it.  

I'll give it till Wednesday and then I'm calling to see if the medical review board has it again. 

I'll keep you posted.

Blessings.

This is really my first blog even though I have been reading and posting since Nov. '96. I haven't had to much to really talk about because I was just waiting for my 6 month supervised diet to be over.  My surgeon had my paperwork for about a month. He reviewed it and they submitted it for approval. From what I can gather it was denied very quickly.  I found out yesterday.  I wanted to know right away the reason why.  All the office could tell me was that the insurance company left a voicemail saying something was up with my 6 month supervised diet and the way it was coded. It was denied.  I really wasn't surprised.  It seems everything little thing is a fight. So I gave myself yesterday to feel sorry for myself and after I spoke to the surgeon's office I called the insurance company.  I left a message with the person who left the original voice mail.  Of course she did not call me back. 

This morning I called the customer service number at BCBS of IL.  The first person I spoke to immediately made me feel she wanted to help me.  She connected me to another person and said she would stay on the line just in case she was needed. (She could have just been nosy, I don't know) The lady she connected me to looked over my file and said that she would have to investigate it more but just by scanning my paperwork a note was left that I did not actively participate in the 6 month diet.  The funny thing is I tried to make sure all of my paperwork was straight because I know the insurance companies MO.  The woman took my number and said she would try to call me back by early this afternoon.  That was at 10:40am.  She called me back at 12:35pm and said that it looks as if two months were missing.  She asked me to have the doctor's office fax those two months with notes to her and she would submit to the medical review board.  I will call the doctor on Monday and ask them to do this.  My surgeon's office also said they would help me get whatever needed to be done but it would have to be on Monday.  I started the ball rolling myself today so now on Monday all i have to do is get them to refax the months that are missing. 

I will post regularly now that the journey has really begun.  It will also help to document what I am doing because my memory leaves much to be desired.  Pleas Pray for me OH that I will be on the losing side soon.