Additional Documentatiom From Insurance Needed

[mike010906 14]

Hello All,

So my info was submitted to the insurance on Monday and the doctor said that they are needing five years of height and weight information from the doctors. I have BCBS which I have heard usually is an easy approval. I have called my primary care and my ob dr for info and they don't have too much, but they have it about three years back (husband was military moved around a lot prior to that). So the dr said to have this sent over and they will resubmit.

Just wondering if this has happened to you all? OBVIOUSLY this has happened with needing extra info with all the hoops that have to be kumped through for approval, but I mean not enough history of height and weight? Any info would be appreciated and I will also let you all know why happens!!! :-)

[ReduceReuseRecycle-Me! 119]

I have concerns over this as well. My patient advocate said that you can write a letter to cover the missing weigh-ins. Obviously, we didn't fan this weight overnight and the insurance should see that, too.

[change4life2012 50]

Hello All' date='

So my info was submitted to the insurance on Monday and the doctor said that they are needing five years of height and weight information from the doctors. I have BCBS which I have heard usually is an easy approval. I have called my primary care and my ob dr for info and they don't have too much, but they have it about three years back (husband was military moved around a lot prior to that). So the dr said to have this sent over and they will resubmit.

Just wondering if this has happened to you all? OBVIOUSLY this has happened with needing extra info with all the hoops that have to be kumped through for approval, but I mean not enough history of height and weight? Any info would be appreciated and I will also let you all know why happens!!! :-)[/quote']

I have BCBS and they wanted additional information as well. I had to submit a letter from my pcp with a three year weight history.it was then approved..

[mike010906 14]

Thanks all!!! My primary care had three weigh ins. Hopefully this will be enough. It was resubmitted to the insurance company yesterday, so I will let you all know what happens!

Hoping for the best!

[shastadaisy 20]

this is what my group says:

Clinical Indications for Bariatric Surgery

• Growth has been completed (18 years of age or documentation of completion of bone growth).
  
• Body mass index (BMI) exceeding 40 or body mass index of 35-39 with at least two of these comorbidities (hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, sleep apnea).
  
• Medical documentation reveals the member has been morbidly obese for five years or more
  
• Medical documentation reveals the member has failed a medically-supervised program of weight reduction spanning at least 6 continuous months of documented monthly weigh-ins, occurring within the 12 months preceding the request. Such a program would be expected to consist of:
  
  • Documentation of nutritional therapy or medical nutrition therapy including a very low calorie diet (e.g. MediFast or OptiFast) unless contraindicated
    
  • Behavior modification or behavioral health interventions,
    
  • Supervised increase in activity
    
  • Pharmacologic therapy (unless contraindicated).
    
  • Maintenance support to continue to encourage nutrition choices to reduce health risk factors and maintain a healthy lifestyle.
    

  [*]The surgical program must document the absence of significant psychopathology that would hinder the ability of an individual to understand the procedure or to comply with medical/surgical recommendations, or that documents psychological readiness for the surgery.

  • Documentation of willingness to comply with preoperative and postoperative treatment plans
    
  • Evaluation by an independent licensed psychologist or psychiatrist unaffiliated with the bariatric center.