Insurane Approval

Jana_anna · November 6, 2007

Hi everyone;

I'm Jan and new to the site. I hope you can help me as I am at my wits end with our insurance company.

I have been working with Vicky at Forest Health Medical Center in Ypsilanti, Michigan for two years to get approval from our insurance ABS-PPOM.

ABS ask for copies of the complete history and physical by the proposed surgeon: this must include CBC, 12-18 chem panel, Thyroid Panel with TSH and VitB 12 Levels, Glucose Tolerance, Liver founctions, Coagulation Profile, Urinalysis, Chest X-ray, Pulmonary Function with ABG's and EKG;

Copies of the pre-Operative medical clearance from your family physician,and Cardiologists or Pulmonologist;

Copies of the psychiaric clearance;

Copies of the physicians records documenting co-morbid conditions including medications.

Documention of a true co-morbidly obese for three years

Copies of pre-operative nutritional counseling, advising patient of post-opeative lifestyle and dietary changes by a registered Dietician.

Copies of the physician's records documenting participation in two physician supervised weight loss programs with the most recent 24 months. The weight loss program must be for a cumulative total of 6 months or longer duration, with the participaion in one program of a least 3 months. This must include documented weigh-in every 1-2 weeks, progress notes, and list any medications percrebed; exercise plan (specifice to include type of exericse, duration and frequency), specifics of diet, and successes or failures of attempts at behavior

modificaton:

Ok so that what they ask for November 21 or 2005. Needless to say all was done and sent and then denied time and time again. they always want sometime more which is never enough.

My family doctor, heart doctor, Orthopaedic doctor (I need both knees replaced), and Vicky have not had any insurance company ask anyone to have as many test and as much documentation.

My question is what Who are you insured by and what are the qualifctions they require? If you could email them to my jaglucas@charter.net I would appricate it very much.

My plan is to take this information to our insurance person for a comparison to other companys and ask why.