Upset: PCP supervised diet - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

jenn75 · 07-01-2008, 07:02 PM

So I finally went to the educational seminar tonight. I have already been to my PCP twice and have been doing Weight Watchers as my supervised diet. I was worried they wouldn't count that.

So at the seminar I asked about the WW, the lady who does the insurance said that was fine, but I had to be meeting with my PCP monthly. I said I was, and that we also talk about exercise as well. Then she said that we could ONLY talk about that subject during our visits, that it wouldn't count if I say, talked about allergies in addition to the weight loss. My PCP's notes could ONLY talk about weight loss.

Well, my heart sank, because for the first visit, we only talked about weight loss, and for that visit, my insurance didn't pay for whatever code they used to bill with. So when I went for visit # 2, they billed with a code for allergies just because the office girl told my PCP to use a different code so it would pay, so she purposefully asked me about my allergies, which there wasn't much to say b/c I'm going to an ENT.

Do you think if I asked my PCP they would resubmit it with the correct code (they gave the correct codes out tonight)? The lady tonight told me we could "chance it", but now I'm a little upset and don't want to start over.

BabyNicole · 07-01-2008, 08:00 PM

Yikes. I honestly don't think they will backcode or backdate anything. Sorry.

Vikkator · 07-02-2008, 07:02 AM

I've had my doctor do it, but mainly because they did it wrong in the first place.

But I'm confused here about what they told you at the seminar. I know every surgeon's way of doing things is different, but it doesn't make sense that you could ONLY talk about weight loss. Do they need copies of the actual doctor's notes? When I approached my PCP, he wrote a letter and submitted info I put together about dates and places where I spent money to lose weight. He didn't include his notes.

jenn75 · 07-02-2008, 08:15 AM

I had asked during the seminar if the insurance companies want to know about my history of dieting, etc., and the surgeon said what's most important, what they really look at, is the 6 month supervised dieting. I got the impression from the lady I talked to afterward who helps submit stuff to the insurance that my PCP would be sending in actual notes, because she was quoting doctor notes...she said, the note can't say "discussed current diet and exercise plan. also discussed stomach problem and prescribed nexium." she said that it wouldn't "count" as a supervised diet visit because we talked about more than the diet/exercise. i think that sounds a bit extreme, but then again, she does this all of the time.

My PCP has done this plenty of times before and has never had a denial, so I will have to clarify with her, and I will even ask her to contact my insurance to find out what they will want at the end of the 6 months to make sure everything is in order. I need to stop stressing about this part. I know I meet the criteria and I will do everything I can do, and the rest is up to those with the knowledge that I don't have to come through for me. I know people have gotten burned that way, but I feel I am in good hands with good experts. I meet w/ my PCP on the 14th and will let her know my concerns.

SueRN · 07-02-2008, 11:30 AM

I can't speak for all insurance companies, but as long as there is documentations that you spoke about diet, weight loss, exercise, etc for a 6 month period-seeing your PCP once a month, we don't give a rats ass what else is in the documentation or what they billed for. Why wouldn't any normal person talk about other issues when they are at the doctor and are already there? Some employers choose to exclude weight loss visits (but they will pay for WLS...go figure). Don't ask the surgeon's office what your insurance company needs....ask your insurance company directly. They are the ones who will be reviewing what the doctor sends them. 10 people can have the same insurance company, they they could each have a different plan that their employer purchased and have add'l rules and guidelines. Hope this helps. Sue

jenn75 · 07-02-2008, 12:20 PM

Quote:

Originally Posted by SueRN

I can't speak for all insurance companies, but as long as there is documentations that you spoke about diet, weight loss, exercise, etc for a 6 month period-seeing your PCP once a month, we don't give a rats ass what else is in the documentation or what they billed for. Why wouldn't any normal person talk about other issues when they are at the doctor and are already there? Some employers choose to exclude weight loss visits (but they will pay for WLS...go figure). Don't ask the surgeon's office what your insurance company needs....ask your insurance company directly. They are the ones who will be reviewing what the doctor sends them. 10 people can have the same insurance company, they they could each have a different plan that their employer purchased and have add'l rules and guidelines. Hope this helps. Sue

Thanks so much! That is very reassuring. I thought it seemed rather extreme. It was only one visit. Plus, what if some medical issue came up in between visits. Are they going to want me to go to the doc TWO different times and pay TWICE? Doesn't make sense!

Godsblessedme · 07-02-2008, 03:17 PM

Quote:

have already been to my PCP twice and have been doing Weight Watchers as my supervised diet. I was worried they wouldn't count that.

i gotta say i'm so surprised your insurance company accepts WW as a "supervised" diet. WOW my insurance only accepted a "medical supervised diet" ie, a physician guided diet only

good luck sounds like your on the right track

soon2bthin · 07-02-2008, 03:30 PM

I was lucky that my insurance was pretty lax and didn't require anything but a bmi over 40. But they did want any doctors notes as to us having discussed weight issues. Good luck with your approval.

mistymee · 07-02-2008, 05:00 PM

Quote:

Originally Posted by Godsblessedme

i gotta say i'm so surprised your insurance company accepts WW as a "supervised" diet. WOW my insurance only accepted a "medical supervised diet" ie, a physician guided diet only

good luck sounds like your on the right track

I think it is because they are also going to the PCP on a monthly basis... so the insurance isn't actually taking WW per se, but the doctors monthly notes when they come in for a weigh in after having attended weekly meetings.

Otherwise, what is a 'physician guided diet' anyway?

jenn75 · 07-02-2008, 09:00 PM

Hey, thanks for all of the feedback. Yeah, I was worried about the WW as diet, too, but honestly it's the only thing my doc has ever recommended that I do when she's told me to lose weight. It's probably very similar to a diet that a nutritionist would put you on anyway, because it factors calories, fat grams, and fiber. Plus, I've lost some weight already, so I'm sure they'd accept it. They better!!!!