Question:
What type of trouble could you face if you alter your medical records?
I know this sounds really bad. I'm worried that my insurance won't approve me for the surgery because I haven't had enough doctor supv. diets. It is one of their requirements. I have been on so many diets! I do not want to wait another year by starting a doctor program right now, that I know will fail. So, I was considering altering my doctor records. I was wondering if anyone knew what kind of trouble I might face if I do this? ...and How could anyone find out? If I don't alter my records, do you have any advice on what I should do? Please, don't think bad of me. I usually have high morals. This weight and years and years of battling it are wearing me out and making me desperate. Thank you for your help. — [Anonymous] (posted on June 6, 2001)
June 6, 2001
Check you records again and most importantly talk with your Doctor. If
he/she is aware that you have tried all the traditional means of losing
weight over a period of time, that might be all you need to satisfy your
insurance. I have to meet the same requirements through my insurance. They
want a 12 month duration of supervised weight loss attempts. It doesn't
specify how current the 12 months has to be. I have documentation
beginning in 1995 and continuing until 1999. Talk with your Dr. and see
what you can get put down on paper. Maybe you can stretch it some. Good
Luck.
— Betty M.
June 6, 2001
Insurance can find out by checking your records against the records they
have of payment. (is this the same insurer you've had for a while)? They
can also request records directly from your doctor which would cause a
discrepancy in your records. I totally understand how you feel though.
It's like, geez you've dieted all your life and now someone is asking you
to prove it. Could you possibly have your doctor write a letter confirming
the numerous diet attempts? Do you have any old Weight Watchers log books
you could give him? How about diet books/cookbooks that you could show the
doctor to give him ample reason to write the letter? Just some ideas.
Good luck!
— [Anonymous]
June 6, 2001
My doctor asked me what kinds of diet I have been on and I told him
"Many",slim fast, dexertrim, grafruit diet, fasting,
fhen-fhen,watermelon,doctor's supervised diet pills,can they prove
watermelon diet? I don't think so, although it happened, never did my
doctor asked me to prove it nor did my insurance company. Stop worring,
wait and see. Most time insurance company do not check they just take the
word of your doctor and the benefit they will gain if you lost weight and
get healhty so they don't have to pay out later. I have been in the same
insurance company for 25 years and only used their services twice and that
was for a cold. So try to relax and pray, God will see you though this.
Good luck
— [Anonymous]
June 6, 2001
It is easy to see and hear the desperation from you. It can make us
consider doing things we would normal not do. However, I would encourage
you to do what you KNOW is the right thing. Altering medical documents in
order to obtain insurance coverage would be considered insurance fraud,
which is a felony, punishable by possible jail time. Be the forthright and
honest person you are. Don't be tempted into something you know isn't the
answer. I wish you the best of luck on this journey.
— BethVBG
June 6, 2001
After read the other posts, I feel like I implied that you cheat your
insurance company. What I meant by "stretch" is (as an
example)that maybe 1 1/2 months of supervised dieting could be counted as 2
months or maybe 11 months of weigh-ins as 1 year, etc... I figure we all
round up to the next number. But, please don't do anything that might get
you into trouble. Good Luck....
— Betty M.
June 6, 2001
First--what type of insurance do you have? Post that, too. Then you can
talk to people who have had to adher to the same guidelines and find out
exactly what constitutes "medically supervised" diet. It is
different depending on who is defining it. No need to risk getting into hot
water when you don't have to.
— Courtney W.
June 6, 2001
Altering medical records is called fraud. I think it is very important
that all of us be as honest as we can when we are talking to the insurance
companies. I think if we maintain our integrity they will eventually see
that the people asking for gastric bypass surgery only want the insurance
coverage they are entitled to under their contract. It is when people
begin to use the fudge factor that we as a group are harmed in the long
run. It makes ins companies suspicious and demand even more records etc to
demonstate to them proof of our need. We want to loose weight not our
integrity. That is something that is more precious than anything we will
gain through this surgery and once it is gone its gone. Hang in there
,work with your doctor and the work you have done, present your best case
but forget the fudge factor. Trust good to bring good.
— [Anonymous]
June 6, 2001
I feel so bad for you. America has to do something to make it easier for
all of to obtain the care that is deemed medically necessary by our
physicians. It is a sad day those billion dollar insurance companies can
tell our doctors how to treat their patients. I would hope that someday
the laws will change to help people like us with our journeys to good
health. I think all of us deserve to live a healthy life no matter what it
costs the insurance companies. We have the right to the pursuit of
happiness, how about the pursuit of good health? We all need to band
together and let our state representatives know what kind of crap we have
had to go through and the dirastic (sp?) measures some of us have gone
through, or thought of going through, to just obtain a healthy body.
Murderers have more rights then we do. I have been at this since December,
so I can only imagine what you are going through. My advice would be to
let your conscience be your guide. Never do anything that you are not
willing to suffer the outcome. You will be in my thoughts.
— charlotte D.
June 6, 2001
My best friend had the same problem you do..they wanted her to do another
year of supervised diet...she just wrote a heartfelt letter detailing her
diets and told them that the end result would be the same...just all from
the heart and she sent it to them when she was denied...and it was her
first appeal and she was approved...no doctors stuff or anything just a
letter and she is getting it done in august.. good luck what ever you
choose.
— Sharon F.
Click Here to Return