I have a date.....I think?!

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

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!

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!

>

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.