Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 In a message dated 7/24/2000 2:51:56 PM Eastern Daylight Time, JBarton101@... writes: << Good Luck! Jeanne >> Many Congratulations Jeanne!!!!!!!! Cathy in Lenoir, NC BMI 42 A journey of a thousand miles begins with a single step Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 Get ready for a long post....sorry but I need help! Great news everybody........I think!? I've been scheduled for August 9. Anybody with the same date? My insurance called Debbie at Dr. R's last Friday and said that all of my information looked good, BUT...... 1. I need a psych evaluation; and 2. I need documentation of nutritional counseling. and here's the kicker....I need it by tomorrow (Tuesday) or I'll be denied and will have to appeal! I scrambled on Friday to find a psychologist that could see me on short notice. I found one that made room for me this morning. His office told me last Friday that it would take two weeks to get the results. So, at Margie (SC)'s suggestion (thanks, Margie), I drafted a note for him to sign at my visit. Well, I went this morning and he was a little taken aback that I had drafted a letter and said that he would not be comfortable signing something he didn't write. (oh, well). He said the biggest problem he had was that a " psychological evaluation " required several visits and some very intensive testing. If, however, I needed a simple screening he could do that in one session. He also said he'd have a letter drafted with the results and would fax it to insurance by the end of the day Tuesday. So, my deep hope is that this will satisfy the insurance company. The psychologist said he felt I was very prepared for the surgery and was very well-read (thanks Dr. R and all of you) on the procedure. Has anybody else had a similar experience? Do you think this letter will be enough? As far as nutritional counseling goes--I've gone to Weight Watchers, TOPS, etc. and received " nutritional counseling. " I was also on an all-liquid diet (Healthy Solutions) through one of the local hospitals. The diet had mandatory weekly nutritional meetings. The diet was supervised by a doctor and I've tried leaving messages for the doc, but haven't received a return phone call. I've also left a message with the insurance company to find out what kind of documentation they need--again, no return phone call. So...I thought I'd write a letter myself explaining the diets and counseling I've received. Has anybody had this same insurance requirement and tried writing a letter? I'm desperately hoping to have the surgery on the scheduled date! In fact, there was an airfare sale that ended last Friday at midnight so I purchased tickets for my husband and me, so I really need to be in North Carolina that week! Any words of advice? Dawn Jester Wichita, Kansas 8/9/00 (hopefully) packet submitted/approved P.S. My thoughts and prayers are with all patients who are have MGB this week! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 Hi Dawn, My insurance also required a psych evaluation. I had a horrible time getting it done quickly without having many, many visits and tests for a whole psych eval, but in the end what happened was the therapist that I ended up with called the insurance company and told them that nothing was wrong with me and that she didn't think I needed a whole lot of testing. They said that just one visit for a screening would be fine, but it needed to be with a psychologist or psychiatrist (she just had her Master's degree), so I saw the psychiatrist that worked at the same place, just once. The therapist wrote the evaluation (with me sitting there - she even asked me how to spell some words and how she should word some things!!), and then the psychiatrist signed it, and it was faxed to my insurance company on a Friday afternoon. The next Monday I was approved by the insurance. So, at least with my insurance, the screening was enough without the psychological testing. I also needed to show some nutritional counseling. I made up a nice looking chart with all of my many diets listed. I had a little synopsis on some of them to say what they had involved and if they involved nutritional counseling. I did have a couple of medical records that briefly mentioned that I had talked to the doctor about weight loss, and one that said I had taken Fen-phen. That was all I had, and apparently it was enough. I think it is ridiculous that they are not giving you hardly any time to get that info to them. The case manager for my insurance told us that she would hold everything until all the information they would need was in because otherwise they would deny me. So that is what she did, and when she felt the info was all in, she sent it on to the doctor who had to decide whether to approve it, and he approved it right away. Couldn't they just hold on to your info until it is all in before it goes to the person who decides? Good luck with this! The insurance hurdle was by far the hardest thing for me. I'll say a prayer for you. Sara MGB 8/2 Dawn Jester wrote: > Get ready for a long post....sorry but I need help! > > Great news everybody........I think!? > > I've been scheduled for August 9. Anybody with the same date? > > My insurance called Debbie at Dr. R's last Friday and said that all > of > my information looked good, BUT...... > > 1. I need a psych evaluation; and > 2. I need documentation of nutritional counseling. > > and here's the kicker....I need it by tomorrow (Tuesday) or I'll be > denied and will have to appeal! > > I scrambled on Friday to find a psychologist that could see me on > short notice. I found one that made room for me this morning. His > office told me last Friday that it would take two weeks to get the > results. So, at Margie (SC)'s suggestion (thanks, Margie), I drafted > a note for him to sign at my visit. > > Well, I went this morning and he was a little taken aback that I had > drafted a letter and said that he would not be comfortable signing > something he didn't write. (oh, well). He said the biggest problem > he had was that a " psychological evaluation " required several visits > and some very intensive testing. If, however, I needed a simple > screening he could do that in one session. He also said he'd have a > letter drafted with the results and would fax it to insurance by the > end of the day Tuesday. So, my deep hope is that this will satisfy > the insurance company. The psychologist said he felt I was very > prepared for the surgery and was very well-read (thanks Dr. R and all > of you) on the procedure. Has anybody else had a similar experience? > Do you think this letter will be enough? > > As far as nutritional counseling goes--I've gone to Weight Watchers, > TOPS, etc. and received " nutritional counseling. " I was also on an > all-liquid diet (Healthy Solutions) through one of the local > hospitals. The diet had mandatory weekly nutritional meetings. The > diet was supervised by a doctor and I've tried leaving messages for > the doc, but haven't received a return phone call. > > I've also left a message with the insurance company to find out what > kind of documentation they need--again, no return phone call. So...I > thought I'd write a letter myself explaining the diets and counseling > I've received. Has anybody had this same insurance requirement and > tried writing a letter? > > I'm desperately hoping to have the surgery on the scheduled date! In > fact, there was an airfare sale that ended last Friday at midnight so > I purchased tickets for my husband and me, so I really need to be in > North Carolina that week! > > Any words of advice? > > Dawn Jester > Wichita, Kansas > 8/9/00 (hopefully) > packet submitted/approved > > P.S. My thoughts and prayers are with all patients who are have MGB > this week! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 Dawn Jester wrote: > > Get ready for a long post....sorry but I need help! > > Great news everybody........I think!? > > I've been scheduled for August 9. Anybody with the same date? Blair is that date, too. > My insurance called Debbie at Dr. R's last Friday and said that all > of > my information looked good, BUT...... > > 1. I need a psych evaluation; and > 2. I need documentation of nutritional counseling. > > and here's the kicker....I need it by tomorrow (Tuesday) or I'll be > denied and will have to appeal! > > I scrambled on Friday to find a psychologist that could see me on > short notice. I found one that made room for me this morning. His > office told me last Friday that it would take two weeks to get the > results. So, at Margie (SC)'s suggestion (thanks, Margie), I drafted > a note for him to sign at my visit. > > Well, I went this morning and he was a little taken aback that I had > drafted a letter and said that he would not be comfortable signing > something he didn't write. (oh, well). He said the biggest problem > he had was that a " psychological evaluation " required several visits > and some very intensive testing. If, however, I needed a simple > screening he could do that in one session. He also said he'd have a > letter drafted with the results and would fax it to insurance by the > end of the day Tuesday. So, my deep hope is that this will satisfy > the insurance company. The psychologist said he felt I was very > prepared for the surgery and was very well-read (thanks Dr. R and all > of you) on the procedure. Has anybody else had a similar experience? > Do you think this letter will be enough? > > As far as nutritional counseling goes--I've gone to Weight Watchers, > TOPS, etc. and received " nutritional counseling. " I was also on an > all-liquid diet (Healthy Solutions) through one of the local > hospitals. The diet had mandatory weekly nutritional meetings. The > diet was supervised by a doctor and I've tried leaving messages for > the doc, but haven't received a return phone call. > > I've also left a message with the insurance company to find out what > kind of documentation they need--again, no return phone call. So...I > thought I'd write a letter myself explaining the diets and counseling > I've received. Has anybody had this same insurance requirement and > tried writing a letter? > > I'm desperately hoping to have the surgery on the scheduled date! In > fact, there was an airfare sale that ended last Friday at midnight so > I purchased tickets for my husband and me, so I really need to be in > North Carolina that week! > > Any words of advice? If you can get the Psych Eval and other info ASAP, you can call the insurance company and find out where to fax it. Fax it with a cover letter explaining you already have a surgery date of Aug. 9 and have already bought airline tickets. > > Dawn Jester > Wichita, Kansas > 8/9/00 (hopefully) > packet submitted/approved > > P.S. My thoughts and prayers are with all patients who are have MGB > this week! > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 >....Couldn't they just hold on to your info until it is all in before it goes to the person who decides? Thanks for your help, Sara! I have a call in for the nurse who is in charge of my approval. I spoke to her on Friday and she was going to see why the doctor set tomorrow as such a hard and fast date. She has not returned my phone call (which seems to be a very common problem these days). I have prepared a letter that outlines my past diets and the nutritional counseling that they included. I hope this is enough! Thanks for your prayers and support! Dawn Jester Wichita, Kansas 8/9/00 Waiting on final insurance approval Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 > If you can get the Psych Eval and other info ASAP, you can call the > insurance company and find out where to fax it. Fax it with a cover > letter explaining you already have a surgery date of Aug. 9 and have > already bought airline tickets. Thanks, . I never thought about a cover letter. I'll be sure to do that with my letter about " nutritional counseling. " Unfortunately, the psychologist did not like the idea of sending me the letter--he said he'd prefer to fax it directly to the insurance company...go figure! Dawn Jester Wichita, Kansas 8/9/00 (hopefully) packet submitted/approved Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 Dawn Jester wrote: > > > > > If you can get the Psych Eval and other info ASAP, you can call the > > insurance company and find out where to fax it. Fax it with a cover > > letter explaining you already have a surgery date of Aug. 9 and have > > already bought airline tickets. > > Thanks, . I never thought about a cover letter. I'll be sure > to do that with my letter about " nutritional counseling. " > Unfortunately, the psychologist did not like the idea of sending me > the letter--he said he'd prefer to fax it directly to the insurance > company...go figure! Then refer to that letter in your cover letter, as in " The following (X) pages are: ________________. " Additionally, you should have already received the psychiatric evaluation from Dr. ___, which was faxed to (xxx) xxx-xxxx on July ___, 2000. " At a minimum, this creates a paper trail for you later, in case they stall or say they didn't get such-and-such. Once they are on notice, they have a duty to respond and any response should note whether they did or did not get the psych eval. You should also get a copy of the psych eval from the doctor yourself. It's nice that he faxed it to them, but you are still entitled to a copy for your records. If you can get that out of them, I'd still put a copy of it with what you are sending to the insurance and just add a line, " Another copy of this evaluation is included for your records. " > > Dawn Jester > Wichita, Kansas > 8/9/00 (hopefully) > packet submitted/approved Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 Hi Dawn, Just bypass the Dr, go straight to the hospital for your records.They are usually regulated by state requirements to have the records available.At one of my hospital diets,I was able to get them that day.Also the hospital has staff that handles nothing but records,Dr's offices it is 'catch as catch can'.Hope this helps.Good Luck, Janet > >Reply-To: MiniGastricBypass (AT) egroups (DOT) com >To: MiniGastricBypass (AT) egroups (DOT) com >Subject: I have a date.....I think?! >Date: Mon, 24 Jul 2000 17:54:25 -0000 > As far as nutritional counseling goes--I've gone to Weight Watchers, >TOPS, etc. and received " nutritional counseling. " I was also on an >all-liquid diet (Healthy Solutions) through one of the local >hospitals. The diet had mandatory weekly nutritional meetings. The >diet was supervised by a doctor and I've tried leaving messages for >the doc, but haven't received a return phone call. > >I've also left a message with the insurance company to find out what >kind of documentation they need--again, no return phone call. So...I >thought I'd write a letter myself explaining the diets and counseling >I've received. Has anybody had this same insurance requirement and >tried writing a letter? > >I'm desperately hoping to have the surgery on the scheduled date! In >fact, there was an airfare sale that ended last Friday at midnight so >I purchased tickets for my husband and me, so I really need to be in >North Carolina that week! > >Any words of advice? > >Dawn Jester >Wichita, Kansas >8/9/00 (hopefully) >packet submitted/approved > >P.S. My thoughts and prayers are with all patients who are have MGB > this week! > ________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 Hi Dawn, Just bypass the Dr, go straight to the hospital for your records.They are usually regulated by state requirements to have the records available.At one of my hospital diets,I was able to get them that day.Also the hospital has staff that handles nothing but records,Dr's offices it is 'catch as catch can'.Hope this helps.Good Luck, Janet > >Reply-To: MiniGastricBypass (AT) egroups (DOT) com >To: MiniGastricBypass (AT) egroups (DOT) com >Subject: I have a date.....I think?! >Date: Mon, 24 Jul 2000 17:54:25 -0000 > As far as nutritional counseling goes--I've gone to Weight Watchers, >TOPS, etc. and received " nutritional counseling. " I was also on an >all-liquid diet (Healthy Solutions) through one of the local >hospitals. The diet had mandatory weekly nutritional meetings. The >diet was supervised by a doctor and I've tried leaving messages for >the doc, but haven't received a return phone call. > >I've also left a message with the insurance company to find out what >kind of documentation they need--again, no return phone call. So...I >thought I'd write a letter myself explaining the diets and counseling >I've received. Has anybody had this same insurance requirement and >tried writing a letter? > >I'm desperately hoping to have the surgery on the scheduled date! In >fact, there was an airfare sale that ended last Friday at midnight so >I purchased tickets for my husband and me, so I really need to be in >North Carolina that week! > >Any words of advice? > >Dawn Jester >Wichita, Kansas >8/9/00 (hopefully) >packet submitted/approved > >P.S. My thoughts and prayers are with all patients who are have MGB > this week! > ________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 Congrats Jeanne, Keep us posted on your progress! Dinah in AL > I just found out now, that my insurance was also approved on this past > Friday. I have e-mailed Debbie to set up a surgery date. Maybe we will be > littermates! I am so excited. My husband on the other hand is VERY > reluctant. Of course he loves me the way I am - unfortunately, I don't! I > am lucky, my insurance has required nothing of me, but I have diabetes, which > they pay alot of money to control! Good Luck! Jeanne Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 Hi Dawn, Maybe it will be enough for them! It really should be. I think that for most of the diets that most of us have been on it is very hard to find documentation, other than our own word, of the things we have tried. And our word should be good enough. Good luck!!!!! Sara Dawn Jester wrote: > > >....Couldn't they just hold on to your info until it is all in > before > it goes to the person who decides? > > Thanks for your help, Sara! I have a call in for the nurse who is in > charge of my approval. I spoke to her on Friday and she was going to > see why the doctor set tomorrow as such a hard and fast date. She > has > not returned my phone call (which seems to be a very common problem > these days). > > I have prepared a letter that outlines my past diets and the > nutritional counseling that they included. I hope this is enough! > > Thanks for your prayers and support! > > Dawn Jester > Wichita, Kansas > 8/9/00 > Waiting on final insurance approval > > ------------------------------------------------------------------------ > 0% Introductory APR! > Instant Approval! > Aria Visa - get yours today. > http://click.egroups.com/1/7102/3/_/453517/_/964475622/ > ------------------------------------------------------------------------ > > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com > Please visit our web site at http://clos.net > Get the Patient Manual at http://clos.net/get_patient_manual.htm > > To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 Hi Dawn, Maybe it will be enough for them! It really should be. I think that for most of the diets that most of us have been on it is very hard to find documentation, other than our own word, of the things we have tried. And our word should be good enough. Good luck!!!!! Sara Dawn Jester wrote: > > >....Couldn't they just hold on to your info until it is all in > before > it goes to the person who decides? > > Thanks for your help, Sara! I have a call in for the nurse who is in > charge of my approval. I spoke to her on Friday and she was going to > see why the doctor set tomorrow as such a hard and fast date. She > has > not returned my phone call (which seems to be a very common problem > these days). > > I have prepared a letter that outlines my past diets and the > nutritional counseling that they included. I hope this is enough! > > Thanks for your prayers and support! > > Dawn Jester > Wichita, Kansas > 8/9/00 > Waiting on final insurance approval > > ------------------------------------------------------------------------ > 0% Introductory APR! > Instant Approval! > Aria Visa - get yours today. > http://click.egroups.com/1/7102/3/_/453517/_/964475622/ > ------------------------------------------------------------------------ > > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com > Please visit our web site at http://clos.net > Get the Patient Manual at http://clos.net/get_patient_manual.htm > > To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com Quote Link to comment Share on other sites More sharing options...
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