Can I Vent Again?

[mendymayhem 52]

So after almost two months, my pcp forwards my records to my surgeon who submitted them for vsg approval.

Denied. Why? Because my pcp failed to note anything about my weight loss efforts between 1/27/12 to 6/04/12! Not a word!

And we all know that six CONSECUTIVE months of pcp documentation is required. Arrrrgghhh! So I made an appointment for tomarrow to see if he will amend my file.

And although I want to go in and give them a piece of my mind, I feel that's gonna work against me at this point.

Worst case, my six months begin on 6/04/12. Did I mention that today was my tentative surgery date? Lovely.

[UTGal99 327]

Oh, boy - that sucks! No other way to put it. There has got to be some way your PCP can resubmit to insurance proving documentation of your visits. Call the insurance coordinator at your surgeon's office. I bet they can light a fire under the insurance company's a$$!

[traceyinflorida 499]

That is frustrating! My bariatric coordinator gave me a sample letter to give to the doctor. I actually filled in my diet history for my PCP as well as all the other info I knew. They filled in the rest. I was trying to find a way to attach the sample letter but there does not seem to be a way to attach it, so I have copied and pasted it below. Maybe it will help. Good luck getting all together. It took me a few tries and a lot of frustration with the process due to various reasons. My physician's letter did not say "I was medically cleared for surgery"...well duh...if they are saying I should have it, doesn't it make sense that they think I am medically cleared to have it. UGHH. Here is the sample letter:

Sample Letter of Medical Necessity:

Give to your primary care physician and to mail completed letter to our office.

[insert date]

RE: [insert patient’s name]

To Whom It May Concern:

Ms. /Mr. [insert patient’s name] has been a patient of mine for [insert number] years. This patient is [insert height] and weighs [insert weight] lbs. with a BMI of [insert BMI]. This patient has been excessively overweight for [insert number] years now and will benefit from bariatric surgery.

In addition to morbid obesity, this patient suffers from the following co-morbid conditions: [insert co morbidities, e.g. diabetes, hypertension, sleep apnea, degenerative joint disease, osteoarthritis, hypercholesterolemia, hyperlipidemia, shortness of breath, exertional dyspnea, urinary incontinence, etc]. Current medical treatment for these co-morbid conditions is

1. .

This patient has tried many methods of weight loss including [insert name of program(s), date(s) started and length of time participated] with [insert number of pounds lost and whether they were regained or not]. This patient is limited due to his/her co-morbidities in his/her ability to exercise but has tried [listing all attempts and any successes or regaining of weight].

This patient's family medical history is indicative for [insert medical condition, e.g. obesity, hypertension, diabetes, hypercholesterolemia, etc].

I respectfully request pre-authorization for insurance coverage for this patient to undergo bariatric surgery. Thank you for your kind consideration in this matter.

Sincerely,

[insert physician's name]

[mendymayhem 52]

That is frustrating! My bariatric coordinator gave me a sample letter to give to the doctor. I actually filled in my diet history for my PCP as well as all the other info I knew. They filled in the rest. I was trying to find a way to attach the sample letter but there does not seem to be a way to attach it' date=' so I have copied and pasted it below. Maybe it will help. Good luck getting all together. It took me a few tries and a lot of frustration with the process due to various reasons. My physician's letter did not say "I was medically cleared for surgery"...well duh...if they are saying I should have it, doesn't it make sense that they think I am medically cleared to have it. UGHH. Here is the sample letter:

Sample Letter of Medical Necessity:

Give to your primary care physician and to mail completed letter to our office.

[insert date']

RE: [insert patient’s name]

To Whom It May Concern:

Ms. /Mr. [insert patient’s name] has been a patient of mine for [insert number] years. This patient is [insert height] and weighs [insert weight] lbs. with a BMI of [insert BMI]. This patient has been excessively overweight for [insert number] years now and will benefit from bariatric surgery.

In addition to morbid obesity, this patient suffers from the following co-morbid conditions: [insert co morbidities, e.g. diabetes, hypertension, sleep apnea, degenerative joint disease, osteoarthritis, hypercholesterolemia, hyperlipidemia, shortness of breath, exertional dyspnea, urinary incontinence, etc]. Current medical treatment for these co-morbid conditions is .

This patient has tried many methods of weight loss including [insert name of program(s), date(s) started and length of time participated] with [insert number of pounds lost and whether they were regained or not]. This patient is limited due to his/her co-morbidities in his/her ability to exercise but has tried .

This patient's family medical history is indicative for [insert medical condition, e.g. obesity, hypertension, diabetes, hypercholesterolemia, etc].

I respectfully request pre-authorization for insurance coverage for this patient to undergo bariatric surgery. Thank you for your kind consideration in this matter.

Sincerely,

[insert physician's name]

Thank you so much for including that form letter. It is very similar to the one my surgeon sent my pcp. We made an appointment and filled it out. I'm grateful that the woman who I deal with at the insurance co takes carefull notes. She is very familiar with my case and can't believe the vague records my pcp has kept. She is gonna go to her sup and fill him in. Hopefully her conversation with him and amended records will get me back on track.

[traceyinflorida 499]

fingers crossed!

[Dooter 1,457]

GRRRRR!!!!!!

[shrinkydinkme 221]

so frustrating... praying for you to get what you need.

[kadive 21]

Same problem here! Cigna requested a peer to peer review with my PCP so hopefully that will work.

[mendymayhem 52]

Is Cigna an insurance company? And what do you mean by peer to peer?

Thanks to all for support.

[Izuri 428]

That's really lame that your PCP's office left out your dieting history. And that today was your tentative date =( It sounds like you are motivated though, so as long as you are on their butts they can still get the correct information in to the insurance company. I'm rooting for you! Let us know how it works out.