Question:
Possible insurance problem?
I've been considering surgery for quite some time now. I have Anthem Blue Preferred (HMO) insurance. The problem is....I got a copy of my medical records from my previous doctor a few days ago, so I could begin the process. He did NOT put anywhere in the chart that I had started weight watchers (doing it on my own with borrowed books). The second problem that I ran into.....the doctor has now closed up his practice and moved OUT of the COUNTRY! I have no idea where. I was extremely lucky to get the copies that I got. I've been seeing my current doctor for about 4 months and she has been documenting everything so far. My insurance requires 18 months of medically supervised weight loss attempts. Nothing that I did on my own....weight watchers, Curves, low-calorie diets, etc....counts! The insurance company doesn't care that I've been trying, with very little success, to lose the weight on my own. I've now been diagonosed with diabetes, hypothyroidism....not to mention all the pain my joints are in from carrying all this excess weight around for more than 15 years. I guess to make a long story short....Am I going to have to basically start all over with the documentation? (except for the 4 months that I already have) — Betsy@goal (posted on December 17, 2003)
December 17, 2003
BESTY I'M IN THE SAME SITUATION. IF ANYONE READS THESE POSTS PLEASE HELP
US....
— Marlo M.
December 17, 2003
Contact your insurance company and ask who bought out his practice. If you
were with a different insurance then contact them. I had the same problem.
I was able to track my records down.
— sherri parker
December 17, 2003
The main problem that I can see is that if your insurance is like my
insurance (Aetna), they wanted copies of my Weight Watchers weigh-in cards
in order to verify attendance. Since you are basically dieting on your own
with the borrowed WW books, did you have monthly weigh-ins at your previous
PCP? If so, those should be documented on your records. If you didn't
have documented PCP weigh-ins, I'm guessing you're going to have a problem
since you can't provide the WW weigh-in card to show that even though your
PCP didn't document it, you were attending.
Good Luck.
— Carolyn M.
December 17, 2003
Orginal poster here....No, unfortuately I don't have the weigh in
cards....all I did was keep track myself. I've already asked the insurance
if they would accept weigh in cards and they replied "no", nor
will they take my personal records. It has to be a "doctor
supervised" weight loss plan. I don't know whether to cry or scream!!
I'm prepared to fight if I have to....no doubt about that. I've already
checked on lawyers. Thanks again everyone.
— Betsy@goal
December 18, 2003
I had Cigna. I had the same problem but in the telephone conference my
lawyer argued about the NIH guidelines and my history and I was approved.
I used Gary Viscio ([email protected]) My opinion is that
they are scared when lawyers get involved because they may have to spend
even more money. Gary said the diet history is a guideline not a policy
requirement and we won. I can tell you he hasnt lost yet. Ask him. And
good luck Ell
— superellen
December 18, 2003
One suggestion (at least a try) would be to have your current Dr. draft a
medical history document where he/she simply restates your medical diet
history extending beyond 18 months. That coupled with your current
diagnosis issues should be very convincing to insurance. In my approval
letter, my "surgeon" only had to state the various medicines I
had tried and the programs I had participated in, not when/how, etc... I
did not call the insurance for anythng until my surgeon sent the approval
letter; otherwise, you place them on alert and they know you're trying to
"get approved." My letter went through in 8 days with a final
approval (and I have Blue Cross, commonly known as tough to get approved).
— T. L. M.
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