I'm Getting the Insurance Runaround... Need Help!

[LosingItIn08 0]

Hi all. I'm brand new to this forum and have been so impressed with all of your weight loss successes and friendly advice. I was hoping you could help me with an insurance saga I've just uncovered.

Long story short, but I've been working w/ UHC for the past several months to have mine & my husband's lap band procedures approved. We've jumped through ever hoop, and thought we were ready to submit for final surgery dates/approval/etc. So today, after spending 2.5 hours on the phone w/ UHC and getting the nastiest most unhelpful people imaginable, I finally got to a helpful person who told me that - oops - you need a 6 month physician supervised diet program.

Now this wouldn't be a huge deal had they told me several months ago when I first started this journey - I'd be almost done by now! However, now I'm back to the starting board.

I have a family member who is a physician and is willing to help us supervise our diets and go back a few months as he's been involved in the whole process, knows weights, etc. This is great but he hasn't done a medically supervised diet before.

What I need your help on is this...

Do any of you have a letter or progress notes that you'd be willing to share so that he can use a similar format? I just need to give him the basic idea of what he needs to write, what he needs to notate, etc.

I would greatly appreciate it! If you could PM me, I could send you my email address. I have a fax as well. I am totally desperate and could not thank you enough.

Thanks everyone in advance!

Stefanie

[Lin12/20/07 0]

Hi- I don't have a letter but I talked extensively with insurance and the insurance person at my doctor's office, who really seemed to know the ins & outs. She made the doctor document every time for the monthly visit, the diagnosis (ex. super morbid obesity) and all co-morbidities (ex. hypertension, sleep apnea, etc) whether or not HE was actually treating me for that- if I had it in my history it went in the chart. also, dr documented discussion on diet & exercise & had me keep a food log & exercise log (similar to fitday.com's or just a table of what you eat & how often you exercise); then, documented that we reviewed those logs. The insurance person told me they don't send those logs but have them in case they ask for them & usually the insurance company will ask to see a few dates.

Also- get the name of every person you talk to at the insurance company and ask for follow up in writing. They are usually reluctant to do this but it doesn't hurt to ask.

Also, have the doctor's office call for the requirements for the surgery- when they do they should be able to list all the things they need to the doctor- ex. psy eval, nutrition eval, 6 months supervised diet & exercise, etc.

Also, check, I saw on someone elses posts that their insurance company didn't count 6 months supervised as 6 visits (ex. June-November= 6 visits). Mine did. Some plans mean 6 periods of 30 days each (ex. June-Dec would be 7 visits but 6 month periods). Whatever you do, don't miss a month, is what they told me so schedule your visits at the beginning of the month so you have time to reschedule it if you have to cancel. Also, if you submit after 6 visits, & don't hear back from them before the 7th visit, make sure you make that 7th visit- from what I understand, the visits must be consecutive or you have to start all over.

I posted recently, I didn't lose any weight during my 6 months supervised period but did end up losing 10 pounds before surgery. But, I submitted to the insurance clerk to submit to insurance along with my claim some additional information.

I submitted a picture of myself thin & chubby. I wanted them to see that I am a person, not just some claim to deny.

I also submitted a list of what I did accomplish during my 6 months supervised diet/exercise. I wrote that I didn't accomplish any weight loss but I did make lifestyle changes in preparation for my band. For example, I stopped soda's, started an exercise regime, started drinking more Water daily, Vitamin regime, read about 6 books on weight loss surgery, (listed by title), etc.

I figured it couldn't hurt!

Good luck to you guys!

[Candle 11]

Did you ask your doctor's office or insurance co if they have a specific form or info they want?

My Lap Band doc had a form that they faxed to my PCP and she just filled it out each month and faxed it back to them. I wish I had a copy to give to you.

It was pretty basic. She recorded my weight each month and made notes about what we discussed as far as diet and exercise. She also made notes about my blood pressure and meds I was on. I think I gained 4lbs on my 6 month "diet" - lol!

Bummer you didn't know sooner .... you'll get there!<!-- google_ad_section_end -->

[Vicki J 0]

Some insurances will take Weight Watcher's or something like that as a supervised diet. Check with them. Also, you can go to bandstersinsurance.com for more information.

[Chris61 0]

It is really amazing how insurnace companies work. I have UHC and my wife and I were approved within one month. We only had to show five years of stuff. We did have a hicup with the getting approved first but we feel that was do to the letter that here pcp wrote. So we went to here OBGYN and he did the same letter and was approved with in 15 minutes after it was refaxed to UHC. If you would like to see the letter e-mail and I will forward you a copy. Good luck with getting approved. It is great having both of us being banded. We help each other out.

Chris

Chris

[lpbndinfo 0]

Sommetimes insurance wants you to get frustrated in having weight loss surgery. That way they win.... Anyway, depending on your coverage, it may not be as expensive to do this out-of-pocket. I help folks all the time that either cant get insurance or they are denied....

Let me know if I can help

Patti

866-484-2263

[WASaBubbleButt 41]

Sommetimes insurance wants you to get frustrated in having weight loss surgery. That way they win.... Anyway, depending on your coverage, it may not be as expensive to do this out-of-pocket. I help folks all the time that either cant get insurance or they are denied....

Let me know if I can help

Patti

866-484-2263

Don't you also recruit patients for Betancourt Medical?

[coltonwade 27]

So Patti, I have always been Curious for you patient coordinators who come on here and post and try to drum up business, do ya'll get so much money PER Patient that comes in , or how does that work ? I have never quite understood what the point is of a doctors staff member coming to a message board to "recruit" patients. So i am curious do ya'll get paid so much per patient a commission or something ??

Just curious

Mindy

[coltonwade 27]

Sommetimes insurance wants you to get frustrated in having weight loss surgery. That way they win.... Anyway, depending on your coverage, it may not be as expensive to do this out-of-pocket. I help folks all the time that either cant get insurance or they are denied....

Let me know if I can help

Patti

866-484-2263

Help , just how do you do that ? Im sure LOTS of people would like to know on here how you can help if insurance denies them .

Mindy

[lpbndinfo 0]

First of all, I am not a recruiter... Secondly, I have worked for doctors in the past... I use to work as volunteer but through countless hours and my day job suffering, I had to make a decision to help people that are looking for alternatives to being able to afford help with wls. I decided that working for a doctor is not what is best for everyone. I feel that there are several good doctors all over the world, as well as bad ones. Through out the years I have gained knowledge about doctors and places... I dont slam other doctors (or someones choice...) I believe that each person has to make that decision for themselves.

When I come to these boards which if you see I have posted less then 15 posts.... I do not come out here to recruit or drive business.... People have legitimate questions and just want advice on possibilities. I have information that I am happy to share with people that dont have insurance and cant afford Mexico... or just dont want to go to Mexico. I talk with individuals about this... I am not here to defend myself nor solicit business. The patients I work with will tell you that I am happy to teach and if they choose a different path, I am happy that I could be of some assistance and let them know that I am always available... It is really ashame that the coordinators that are out there cant share for fear of attack from those who post out here. I have spent more time explaining who I am then actually helping a person that may have a question or concern. I wish everyone the best in their journey... I think that you have to do a lot of research when deciding which doctor and facility you are planning to have your surgery at. I have learned a lot about doctors in Mexico as well as in the states. There are certain "pat answers" that are given whether they are true or not, by doctors and staff. I try to help people weed thru the curriculums and posts about doctors and places...

I can not help that these are shark infested waters... here and at other message board sites. It is because of this that I rarely come to answer questions... Or even ask others about their postings. If everyone would stick to their story, their personal experience and didnt gossip.... Because gossip is taking one persons story (hearsay) and spreading it like wild fire. Before posting things about doctors it may be wise to ask yourself.... IS it true? Is it accurate? Has the person posting these horrific situations been checked out to see if it is their experience. Are you sure that the person posting doesnt work for a doctor and wanting to stop business for another team?

For myself, I try really hard not to get caught up in this sort of stuff. I help people for free and not everything I do is to put $$ into my pocket. I hope there are other coordinators, doctors, nurses, patients that DO help without bashing and wanting to gain personally... It is is ashame that these message boards cant be open enough to let those who want to help... help.

[coltonwade 27]

First of all, I am not a recruiter... Secondly, I have worked for doctors in the past... I use to work as volunteer but through countless hours and my day job suffering, I had to make a decision to help people that are looking for alternatives to being able to afford help with wls. I decided that working for a doctor is not what is best for everyone. I feel that there are several good doctors all over the world, as well as bad ones. Through out the years I have gained knowledge about doctors and places... I dont slam other doctors (or someones choice...) I believe that each person has to make that decision for themselves.

When I come to these boards which if you see I have posted less then 15 posts.... I do not come out here to recruit or drive business.... People have legitimate questions and just want advice on possibilities. I have information that I am happy to share with people that dont have insurance and cant afford Mexico... or just dont want to go to Mexico. I talk with individuals about this... I am not here to defend myself nor solicit business. The patients I work with will tell you that I am happy to teach and if they choose a different path, I am happy that I could be of some assistance and let them know that I am always available... It is really ashame that the coordinators that are out there cant share for fear of attack from those who post out here. I have spent more time explaining who I am then actually helping a person that may have a question or concern. I wish everyone the best in their journey... I think that you have to do a lot of research when deciding which doctor and facility you are planning to have your surgery at. I have learned a lot about doctors in Mexico as well as in the states. There are certain "pat answers" that are given whether they are true or not, by doctors and staff. I try to help people weed thru the curriculums and posts about doctors and places...

I can not help that these are shark infested waters... here and at other message board sites. It is because of this that I rarely come to answer questions... Or even ask others about their postings. If everyone would stick to their story, their personal experience and didnt gossip.... Because gossip is taking one persons story (hearsay) and spreading it like wild fire. Before posting things about doctors it may be wise to ask yourself.... IS it true? Is it accurate? Has the person posting these horrific situations been checked out to see if it is their experience. Are you sure that the person posting doesnt work for a doctor and wanting to stop business for another team?

For myself, I try really hard not to get caught up in this sort of stuff. I help people for free and not everything I do is to put $$ into my pocket. I hope there are other coordinators, doctors, nurses, patients that DO help without bashing and wanting to gain personally... It is is ashame that these message boards cant be open enough to let those who want to help... help.

Ok you might not be a recruiter but you ARE A patient coordinator for a doctor correct ? MY Issue is that that is not being convied up front to people . You said you can help people if they have been denied insurance. Then why not tell EVERYONE on the boards your experience instead of telling people to call you at your WORK number or email you at your WORK email ? That is what is fishy to me ?

I had problems getting financed due to my credit , I tell people how I got my credit cleaned up from what i know so they can get financed. I work for NO ONE . But im trying to help others get the surgery I did. I will tell anyone on this board right now ON the boards. Why is that not something you do ? If you want to HELP ? I agree their are coordinators, nurses, docs ect that do some shady things on here. I dont know maybe its just me , but something that is shady to ME is NOT being up front that your a coordinator FOR a doc ? If your a patient on here as a patient, fine but dont tell people to contact you at your WORK so you can "Help" them , you have to admit THAT IS not cool .

Mindy

[Candle 11]

Right on, Mindy!!

I also had trouble getting insurance approval and offer to help anyone in my situation* right here on the board for all to read. If *all* you really want to do is HELP people - why not share your info publicly?

*People that live in NY <!-- google_ad_section_end -->

[coltonwade 27]

Right on, Mindy!!

I also had trouble getting insurance approval and offer to help anyone in my situation* right here on the board for all to read. If *all* you really want to do is HELP people - why not share your info publicly?

*People that live in NY <!-- google_ad_section_end -->

Right, its not like only ONE person on this board needs the help . The fact is over half the people on here have to go self pay . its probably ALOT higher than that. So if people are here to help then share the info !

Thanks Candle

Mindy

[WASaBubbleButt 41]

First of all, I am not a recruiter... Secondly, I have worked for doctors in the past... I use to work as volunteer but through countless hours and my day job suffering, I had to make a decision to help people that are looking for alternatives to being able to afford help with wls. I decided that working for a doctor is not what is best for everyone. I feel that there are several good doctors all over the world, as well as bad ones. Through out the years I have gained knowledge about doctors and places... I dont slam other doctors (or someones choice...) I believe that each person has to make that decision for themselves.

When I come to these boards which if you see I have posted less then 15 posts.... I do not come out here to recruit or drive business.... People have legitimate questions and just want advice on possibilities. I have information that I am happy to share with people that dont have insurance and cant afford Mexico... or just dont want to go to Mexico. I talk with individuals about this... I am not here to defend myself nor solicit business. The patients I work with will tell you that I am happy to teach and if they choose a different path, I am happy that I could be of some assistance and let them know that I am always available... It is really ashame that the coordinators that are out there cant share for fear of attack from those who post out here. I have spent more time explaining who I am then actually helping a person that may have a question or concern. I wish everyone the best in their journey... I think that you have to do a lot of research when deciding which doctor and facility you are planning to have your surgery at. I have learned a lot about doctors in Mexico as well as in the states. There are certain "pat answers" that are given whether they are true or not, by doctors and staff. I try to help people weed thru the curriculums and posts about doctors and places...

I can not help that these are shark infested waters... here and at other message board sites. It is because of this that I rarely come to answer questions... Or even ask others about their postings. If everyone would stick to their story, their personal experience and didnt gossip.... Because gossip is taking one persons story (hearsay) and spreading it like wild fire. Before posting things about doctors it may be wise to ask yourself.... IS it true? Is it accurate? Has the person posting these horrific situations been checked out to see if it is their experience. Are you sure that the person posting doesnt work for a doctor and wanting to stop business for another team?

For myself, I try really hard not to get caught up in this sort of stuff. I help people for free and not everything I do is to put $$ into my pocket. I hope there are other coordinators, doctors, nurses, patients that DO help without bashing and wanting to gain personally... It is is ashame that these message boards cant be open enough to let those who want to help... help.

If you aren't a coordinator or recruiter, what do you call it when you are paid to send people to a given list of doctors?

Your phone number (on another post) matches a phone number of an email I have from some time back when my name was passed to you and you suggested I go to Betancourt Medical for a band.

We all share information here, links, links to people with personal experiences. As I told you in the PM last night, I believe it is unethical to only share the good experiences and not the bad as well. People have the right to make informed decisions. If they have all the information available to them and they still decide to go to someone with less than a stellar reputation, that's on them. But if they are only given bits and pieces (good info only) they have no idea how to make a decision that is good for them.

Lauren and I have spent a great deal of time with a post (my sig link) showing people a starting point with a written check list to research doctors. We don't decide which doctor is best for them, we provide the tools for the patient to research ALL doctors and make the right decision for their choices and preferences.

[coltonwade 27]

I guess I did not use the "Correct " word so she didnt feel the need to disclose her proper title ?

Mindy