Will you show me yours...?

[KittyChick 140]

Hi all,

I new to the community and need help on the proper paperwork to send to BCBS of CA PPO (or any other provider who requires these things specifically.)

They require:

History and physical w/prior weight loss attempts

Non surgical weight reduction program (PCP supervised, inital and end weight, duration with start and end dates.

Description of exercise program and duration or medical contraindication to an exercise program

Monthly documentation of weight over 6 consecutive months (medical records and/or weight loss logs)

Monthly documentation of dietary regimen, physical exercise, and behavior modification for 6 consecutive months (medical records and/or weight loss logs)

Nutritional consultation

Psychological consultation showing patient cleared for surgery

Medical doctor order for surgery that inclues weight, height, BMI, surgery requested and recommendation

The nutional consult and psych consult will be done by the hospital's bariatric surgery dept. so I'm not worried about those. It's the REST of this stuff that I'm concerned with. My PCP doesn't have a lot of experience with these requests and we need to make sure the documentation is PRECISE so I will be approved right out of the gate.

Is anyone willing to share with me the documentation submitted to your ins co? You can email it to me and black out any personal info and weigh in specifics. I just need the format in which we should submit this cause we need to know how everything should look. If anyone would be so kind as to do this for me, I will be profoundly grateful.

[Olarance75 215]

The documentation from your primary care doctor consists of notes from each of your visits where you have discussed weight loss

[acubi2 33]

Have you been to your first appointment yet? Once I called to make my first appointment my doctors office sent me a 16 page packet that had a lot of information for me to fill in. I also have anthem BCBS and was approved within a month with no extra paperwork. I am not sure if that helps, during my psych appointment we went back over all of the diets that I have been on as well.

[mokee 588]

Your surgeon has a staff that will handle all this for you. You are paying for this service use it.

[Bufflehead 6,358]

Ditto what mokee said. The formatting and wording of letters and documentation should not be your concern. Your surgeon's insurance coordinator is supposed to know all that and make sure that everything collected from other doctors etc. is correct and complete. If they are telling you that you need to be in charge of that, I would be very concerned.

[outwithbenjiboi 227]

The six months of documentation is what you have to amass over the NEXT six months with your PCP.

For me (Federal BC/BS) it was only three months, but here's what I did:

1. Saw my PCP in April 2013 and gave him my entire weight narrative (fat kid, first diet at 13, attempts at weight watchers, 70 lb loss on Phen/Fen and subsequent regain etc etc)

2. Started meeting weekly with a dietician. We focused on Portion Control and 10,000 steps per day. She documented our weekly meetings and my progress, and sent all of these records to my PCP.

3. Met with my PCP monthly to be weighed and go over my plan, progress.

4. Met the pre-surgeon meeting requirements with my closest center for excellence (Johns Hopkins)

5. Met their criteria (sleep study, nutritionist, psych eval, gathering assorted other records from endoscopy, ob/gyn etc).

6. Made sure my dietician, PCP, and all other records got to my surgeon.

7. The specialist at my surgeon's office put the package together for submission to the insurance company.

I got approved within one week.

[KittyChick 140]

Thank you all for your responses.

I went to the initial 2 hour group seminar with the bariatric surgeon at the hospital and they did give me a huge packet afterward. When they asked for the ins info, I told them I currently have an *** that doesn't cover weight loss surgeries and would have BCBS on January 1st. They wouldn't make an appt. with me until Jan, so my PCP and I have decided to get a 3 month jump on the 6 month requirement so I could seek approval by March. My PCP wanted some specifics on format/documentation but it looks like I'll have to wait to see the surgery center in Jan?

[KittyChick 140]

Um...guess you can't type H M O on this board or they'll *** it out

[Mkak 251]

Oh my gosh why would they censor H.M.O.? LOL! Does it stand for something else that is offensive? Haha I'm laughing out loud for real right now!