Insurance Requesting 12 month diet info

MMDLynn · July 19, 2005

My insurance has sent a letter to lap band surgeon requesting more detailed information on the past 12months of physician monitored diet & exercise plan.

Does anyone have samples of what this information looks like on paper? My physician has hired a new admin asst. and she says she doesn't know what they are looking for. Now I'm up against the wall and I have to provide the lap band surgeon with this information from June 2004-June 2005.

Does anyone have samples they could share, so that I can help walk this admin asst through this process?

Thanks, signed desperately seeking surgery

FRECKLES3 · July 19, 2005

My Insurance Company Requested What Is Called An H&p (history And Physical) On Diet And Exercise Monitoring Or I Could Submit My Own Journal. I Just Sat Down On The Computer And Went Over Every Diet And Exercise Program I Have Tried. Then I Had My Doctor Submit Any H&p's They Had Relating To Weight Issues I Had Gone To The Doctor About. Every Time You See Your Doctor They Should Fill Out An H&p On You. The Adm. Assistant Needs To Give You Copies Of These Or Send Them In For You To The Insurance Company. Good Luck

MMDLynn · July 19, 2005

Thanks Rachael, that helps. I think I will have to document my journal of weight loss attempts along with my current physicians info. At least I know where to start - did they just need a date, diet & exercise plan and weigh-in for that visit?

FRECKLES3 · July 19, 2005

all my insurance company requested was that either by the doctors office or my own letter i show documentation of a diet/excercise plan that has been attempted. i didnt have any dates, i just stated that i had tried weight watchers twice and failed, Atkins once and ended up in the er with a kidney stone, i belong to a gym..those types of things...the h&P's from the doctors office basically showed my weight documented and for example " i went to the dr once to talk about weight loss and he suggested a dietician"....they have to document what you go there for and what the recommendations were that were given

MMDLynn · July 19, 2005

I see, so you've been approved already or are you awaiting approval from the insurance company?

the best me · July 19, 2005

Lynn, you may also be able to get a letter from your OBGyn documenting your weight? I don't know that this qualifies as weight loss attempts, but if your doc said "follow south Beach" and you did for 6 weeks and lost 10 pounds then gained 15 after stopping the plan? I dunno. Just throwing it out there.

Start writing notes to yourself about your weight loss history...even put it in list form. I had a list made that looked like this:

April 1997 168 pounds ( I know this because that's when I was married)

December 1998 208 pounds (quit smoking, gained weight) (I know this weight because I got pregnant then)

etc... so I made the whole page of this long list saying what I did, how much I weighed and the months and years. My PCP made a photocopy of it and put it in my medical record. It was NOT fancy! Hand-written on yellow legal paper. She treated it like GOLD! Maybe if you get something typed up from your head and give it to your doc, it becomes part of your medical record and has some "official" status.

Let us know...

FRECKLES3 · July 19, 2005

I Have Been Approved For A Visit With The Surgeon. I Still Have To Take A $500 Educational Class That Tells You All About The Procedure, Risks, Diet, Etc And Then I Have To Get A Psych Evalution And Then I Can Have The Surgery If I Do All That And Pass!!

MMDLynn · July 19, 2005

Thank you ladies, this really helps me a lot. Kathy I will tranfer all of my personal documentations (dates/weight, etc.) from my Jenny Craig, Nutrisystem, Weight Watchers, Adkins diet phases over the past 2 years. I'll have my doctor add them to my medical file if possible - the difficult thing is that I've changed doctors with 3 times in the past 2 years, and my current doctor is only a couple of months old. I guess I'll have to go through my OB/GYN to see if she will work with me and have this info added to my file.

Alexandra · July 19, 2005

Lynn, I think that your insurer is looking for doctors' notes, not your own notes. If you haven't been seeing this physician for the last 12 months on a regular basis in an attempt to control your weight, you probably haven't done what they're looking for.

However, if your doctor is cooperative and you can get your OB/GYN to provide the same info, you may be able to put together enough data to satisfy your insurer. The important thing is your doctors' saying that you came to them seeking medical care for your weight problem. If there are notes in your files for visits in which you and the doctor talked about your weight, those are the dates to be listed. I was able to use notes from my OB/GYN that had been taken during prenatal visits two years before. Every single visit my weight was a topic of discussion.