Letter to Insurance - Time Sensitive - ThinnerTimes

FitGator · 08-08-2006, 02:20 PM

Dear Board Members - I Need you help:

I was on the phone today with my insurance company as they requested additional information regarding the 6 month supervised nutrition program. I informed them that even though I do not have evidence of a “documented” program I have been under the care of my PCP since September 05.

I have seen my PCP, 3 times in person and several others on the phone since 9/05. Every time my weight has been part of the conversation as I have shared all my failed attempts at losing weight. She even prescribed Xenecal (which did not work me) and she was the one who referred me to the Gastric Bypass Surgeon. She even wrote a letter of medical necessity that was included in the request submitted for the WLS surgery.

So this conversation with the insurance company is going in circles and I just asked the person what else would your company accept in lieu of the 6-month program. He very nicely suggested that an additional letter from my PCP addressing her conversations with me to demonstrate my attempts to meet the criteria could strengthen my case.

So I get on the phone with my PCP’s office and I shared the above information with my doctor’s assistants. A lady who has gone above and beyond to help every time I call. My doctor won’t be in till Thursday so I have to wait till then, fine I’ll wait.

Well a few minutes later the Office Manager called me and offered me the following: That I write the letter to say what I want it to say and fax it to them and they will put it on their letter head have the doctor review and sign it and send it wherever I want. (This would save them so much time and would be easier for them to go this route!!)

Hey no problem, get right on it you’ll have first thing in the morning…my question to the board…what do you suggest I put on this letter to be as effective as possible?

Sorry for the lengthy explanation.

Cinerbelle · 08-08-2006, 02:26 PM

Hey Gator,

Besides all the fluffy stuff you need to put specific dates, times, what was said...be VERY detailed. My Medical Group required their own 6 moth supervised diet...so I had no way around it. It was still worth it....got my mind in a good place going into the surgery. Yeah, I hated waiting...but it went by really fast!

ready4achange · 08-08-2006, 02:56 PM

Quote:

Well a few minutes later the Office Manager called me and offered me the following: That I write the letter to say what I want it to say and fax it to them and they will put it on their letter head have the doctor review and sign it and send it wherever I want. (This would save them so much time and would be easier for them to go this route!!)

My doctor said the same thing to me. Since I knew all the things I did to lose weight that was fine. He just rewrote it to include medical necessity for surgery. I had done WW at least half a dozen times but I think if I needed documentation I probably would have been able to get it. He read me the letter before he sent it....Good Luck
Sandy

kat4752 · 08-09-2006, 04:16 PM

Im' waiting on insurance approval too. Good-luck to you & make sure your letter lists dates you exercised & what types of exercise you did(very important)

Quote:

Originally Posted by FitGator

Dear Board Members - I Need you help:

I was on the phone today with my insurance company as they requested additional information regarding the 6 month supervised nutrition program. I informed them that even though I do not have evidence of a “documented” program I have been under the care of my PCP since September 05.

I have seen my PCP, 3 times in person and several others on the phone since 9/05. Every time my weight has been part of the conversation as I have shared all my failed attempts at losing weight. She even prescribed Xenecal (which did not work me) and she was the one who referred me to the Gastric Bypass Surgeon. She even wrote a letter of medical necessity that was included in the request submitted for the WLS surgery.

So this conversation with the insurance company is going in circles and I just asked the person what else would your company accept in lieu of the 6-month program. He very nicely suggested that an additional letter from my PCP addressing her conversations with me to demonstrate my attempts to meet the criteria could strengthen my case.

So I get on the phone with my PCP’s office and I shared the above information with my doctor’s assistants. A lady who has gone above and beyond to help every time I call. My doctor won’t be in till Thursday so I have to wait till then, fine I’ll wait.

Well a few minutes later the Office Manager called me and offered me the following: That I write the letter to say what I want it to say and fax it to them and they will put it on their letter head have the doctor review and sign it and send it wherever I want. (This would save them so much time and would be easier for them to go this route!!)

Hey no problem, get right on it you’ll have first thing in the morning…my question to the board…what do you suggest I put on this letter to be as effective as possible?

Sorry for the lengthy explanation.