Need Advice Before Submitting to Insurance

[Mija 0]

Hello everyone! I am sooo very close to submitting my paperwork to my insurance company but i want to make sure i have somethign straight before i do. I have Optimum Choice which is a part of United Healthcare and part of my requirements for approval are to show 6 months of being on a weight loss plan (ie: Jenny Craig, Weight Watchers, seeing a nutrionist). It does not say that my doctor has to be monitoring my progress. I have been seeing a nutrionist for several months so i will be using her notes to submit when its time.

Here is my question...does anyone know the format of how these notes should be? Are they supposed to be very formal? She basically just puts what my latest weight is, what ive been eating, exercising etc. I will be the first person she submits notes on for Lap Band and i want to make sure i dont prolong the process by submitting things that arent acceptable to the insurance company. When we called them to ask exactly how they wanted it they just said to send in her notes. But im scared when we do they will want it to be more detailed or something and then i will get denied. Any advice and comments are appreciated!

thanks! Nikki

[Mariasha 3]

Check with your surgeons office. They should be able to guide you through this.

[Mija 0]

Great idea! I go to my surgeons office tomorrow to meet with their dietician for a required visit...maybe they can help. Thank you!

[bunnyluv37 1]

HELLO MY INSURANCED REQUIRED THE SAME THING YOU ARE FINE MY NUTRITIONIST DID ALOT OF THINGS THRU EMAIL FAR AS MY WEIGHTS AND I WENT TO PRE OP CLASSES U RE FINE I GOT APPROVED IN 1 DAY MY DATE IS 11/29 WHOOOOOOOOOOO!!!!:huh2:

[Sabrina0916 0]

Hi Nikki.

I'm a little shy but coming around to this site. Decided to send a private message on this one. I am a nurse and deal with prior authorizations frequently but not for bariatric surgery so this experience was somewhat of a double edged sword. I have Aetna and they required 6 month supervision as well. It so happens that my psychologist that my bariatric surgeon referred me to was under my insurance and dealt specifically with weight related issues and emotional eating is a big percent of my problem and we collaboratively decided that I should see her monthly for my "medically supervised medical evaluation". What they required was a monthly height and weight and a discussion on weightloss and some sort of changes you made re: your diet. For example, during my 6 months I actually put on weight, about 10lbs which to me validates my emotional eating as I reacted to the news about the 6 months wait but then I started to journal and talk about my eating habits and how I modified them and lost only 5 lbs in the 6 months but I think bad habits were changed which worked in my favor. I found out today I got approved!! I decided to submit a letter on my own behalf, alot of the information I got right from this site. I think I searched medical necessity letter and I curtailed it to me. I talked about my attemps and the research I have done. I talked about my family history of heart disease and diabetes on both sides and how my siblings struggle with weight and how one has high blood pressure. One will never know if this worked in my favor but I think it did. It added personalization about my story and my efforts outside of medical requirements. I thought I'd share the info. Good luck!