Put on the brakes..... have to have 5 more PCP visits with documentation

Neanie in Texas · January 17, 2011

Well, thought I was about finished all the requirements to get a surgery date and then the PCP records arrived and put on the brakes. My PCP did not have adequate documentation of weight loss supervision to qualify for the insurance company to approve me for surgery. You go to a doctor and he has prescribed

Adipex and monitored my weight and exercise and diet but fails to document in his records. I was just appauled. Now I have one month that will qualify for the documented weight loss supervised doctor visits. Now I have to go through 5 months more before I can get a surgery date. The good thing is that I have everything else taken care of and do not have to repeat anything. So as soon as the visits are done, will submit to insurance company for approval and get my date scheduled for surgery.

Just an FYI from someone that learned a valuable lesson, when you are trying to get your physician supervised weight loss visits documented make sure that the visit shows that you are there specifically for a supervised weight loss visit. You will need to have documentation for your means of diet, exercise, and what the supervision consists of. If I had had this I would be having surgery next month, now it will be June. I will do what ever I have to do in order to have the insurance company pay for my surgery so for a few more months I will just keep on going on.

I will make it as I am determined to make my goal.

Neanie

smcsleeve · February 1, 2011

Thanks for the advice. I might be a little late to the party, but it's timely advice for me today. I just spoke with my insurance (UHC) today and they told me I needed 6 months supervised diet with PCP or nutritionist. The documentation has to be very specific about diet, exercise and weight for each visit. I was a little downhearted at first, because when I met with the surgeons office I was told that UHC didn't require any supervised diet. I just felt that it had taken me YEARS to get the the point when I really wanted this surgery, and I'm there now and I'm ready to go!!!!! Ah well, I will do whatever is necessary if it means I get approved for surgery.

smcsleeve

Well, thought I was about finished all the requirements to get a surgery date and then the PCP records arrived and put on the brakes. My PCP did not have adequate documentation of weight loss supervision to qualify for the insurance company to approve me for surgery. You go to a doctor and he has prescribed

Adipex and monitored my weight and exercise and diet but fails to document in his records. I was just appauled. Now I have one month that will qualify for the documented weight loss supervised doctor visits. Now I have to go through 5 months more before I can get a surgery date. The good thing is that I have everything else taken care of and do not have to repeat anything. So as soon as the visits are done, will submit to insurance company for approval and get my date scheduled for surgery.

Just an FYI from someone that learned a valuable lesson, when you are trying to get your physician supervised weight loss visits documented make sure that the visit shows that you are there specifically for a supervised weight loss visit. You will need to have documentation for your means of diet, exercise, and what the supervision consists of. If I had had this I would be having surgery next month, now it will be June. I will do what ever I have to do in order to have the insurance company pay for my surgery so for a few more months I will just keep on going on.

I will make it as I am determined to make my goal.

Neanie

Neanie in Texas · February 2, 2011

Thanks for the advice. I might be a little late to the party, but it's timely advice for me today. I just spoke with my insurance (UHC) today and they told me I needed 6 months supervised diet with PCP or nutritionist. The documentation has to be very specific about diet, exercise and weight for each visit. I was a little downhearted at first, because when I met with the surgeons office I was told that UHC didn't require any supervised diet. I just felt that it had taken me YEARS to get the the point when I really wanted this surgery, and I'm there now and I'm ready to go!!!!! Ah well, I will do whatever is necessary if it means I get approved for surgery.

smcsleeve

I felt the same way. I had spoken to my insurance company and they did not tell me about the 6 supervised visits. BUT, I cannot write the Dr. or hospital a check so I need the insurance company to pay so I will do what they say. I only lack 4 more visits. Time goes by too quickly anyway so I will make it. I have a lot of things I want to get done around my house so I will concentrate on that prior to surgery. You will make it too. Find something to do to occupy your time. Follow all of their rules and we will be on the other side of surgery before we know it.

Neanie

Crabadams72 · February 3, 2011

I felt the same way. I had spoken to my insurance company and they did not tell me about the 6 supervised visits. BUT, I cannot write the Dr. or hospital a check so I need the insurance company to pay so I will do what they say. I only lack 4 more visits. Time goes by too quickly anyway so I will make it. I have a lot of things I want to get done around my house so I will concentrate on that prior to surgery. You will make it too. Find something to do to occupy your time. Follow all of their rules and we will be on the other side of surgery before we know it.

Neanie

AMAZING!. I experienced the same thing today!.

I went to my PCP because I was having back pain from a UTI.

I started going to this Dr in November right after my WLS seminar. At the VERY 1st visit I discussed my desire to get weight loss surgery. I think at that time I wanted the band. We talked about diet and everything. (NO notes were made regarding this!)

They immediately set me up for the testing-EGD,Ultrasound --etc. These were done in December. I went back at the end of Dec to get test results (I was not weighed and no diet talk occured)

I went back in Jan and the Dr. notes the diet discussion and my weight this time!.

I was thinking I would get the surgery in April and be looking good for summer. Now I am getting the surgery in June--so no chance of being in onderland for my birthday in July

I "thought" I was doing my part but the Dr. wasn't and I will be submitting a very detailed spreadsheet with meal plans (pulled of the internet), and workout schedule.

Also remember UHC is looking for a FAILED weight loss attempt AND UHC wants your last 5yrs of weights or they will deny.