Guest guest Posted August 7, 2007 Report Share Posted August 7, 2007 BCBS typically requires 6 months of diet documentation. Apparently we are having problems getting a lot of these patients approved for surgery with BCBS even when they have 6 months of diet doc. I always see a patient for a nutrition consult where I review their diet history, weight history, medical history, exercise as well as give patients information regarding pre and post op dietary/exercise expectations. I always review the behavior changes that are necessary for success with the lap band. If I feel the patient is not prepared I will schedule a f/u appointment to make sure the patient is on track before surgery. Apparently, from what the insurance coordinator is telling me, this isn't good enough?!? I feel like I am providing all the right information for the patient and I use my discretion along with the psychologist to decide whether the patient is prepared and ready for sx. Does anyone have problems regarding this? I'm not sure what to do regarding these patients anymore?!? Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2007 Report Share Posted August 7, 2007 They are asking you to either do 6 months or diet education and weight loss with the patient or the patient needs to provide documentation of doing that elsewhere. We have a number of different insurance companies that look for 3-12 months of documentation so we have the patients come back monthly for the required time to meet with RD and PT to discuss diet and activity changes and we have no problem getting them covered after that (even if the patient does not really make any progress)! Hope this helps Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135 -----Original Message-----From: [mailto: ]On Behalf Of kimbo083Sent: Tuesday, August 07, 2007 1:02 PM Subject: BCBS Insurance BCBS typically requires 6 months of diet documentation. Apparently we are having problems getting a lot of these patients approved for surgery with BCBS even when they have 6 months of diet doc. I always see a patient for a nutrition consult where I review their diet history, weight history, medical history, exercise as well as give patients information regarding pre and post op dietary/exercise expectations. I always review the behavior changes that are necessary for success with the lap band. If I feel the patient is not prepared I will schedule a f/u appointment to make sure the patient is on track before surgery. Apparently, from what the insurance coordinator is telling me, this isn't good enough?!? I feel like I am providing all the right information for the patient and I use my discretion along with the psychologist to decide whether the patient is prepared and ready for sx. Does anyone have problems regarding this? I'm not sure what to do regarding these patients anymore?!? Thanks! IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2007 Report Share Posted August 7, 2007 I am so glad this subject was brought up. I work in a diabetes education center as an educator, but since I am the RD, I see many patients considering gastric bypass and do the 6 month documentation. What ARE they looking for? Is there a check-list or something I should include in my documentation so that these patients won't be denied? Thanks Arini, RD,CD Registered Dietitian Union Hospital Diabetes Education Center 1530 N. 7th Street Suite 503 Terre Haute, IN 47807 (812) 238-7577 >>> kimbo083@... 08/07/07 4:01 PM >>> BCBS typically requires 6 months of diet documentation. Apparently we are having problems getting a lot of these patients approved for surgery with BCBS even when they have 6 months of diet doc. I always see a patient for a nutrition consult where I review their diet history, weight history, medical history, exercise as well as give patients information regarding pre and post op dietary/exercise expectations. I always review the behavior changes that are necessary for success with the lap band. If I feel the patient is not prepared I will schedule a f/u appointment to make sure the patient is on track before surgery. Apparently, from what the insurance coordinator is telling me, this isn't good enough?!? I feel like I am providing all the right information for the patient and I use my discretion along with the psychologist to decide whether the patient is prepared and ready for sx. Does anyone have problems regarding this? I'm not sure what to do regarding these patients anymore?!? Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2007 Report Share Posted August 7, 2007 I understand the 6 months of diet documentation that is needed for BCBS. I don't do that at our facility, however, because BCBS sees that as a conflict of interest since I work for the bariatric program. Apparently, they are having problems with my notes coinciding with that of the 6 month diet doc program?!? I'm getting extremely frustrated with our insurance coordinator because I don't know what she is looking for or what they want!! I feel like I touch base on everything necessary with the patient for success with the lap band. I'm not sure what to do at this point?!? Thanks!"Laschkwitsch, :LPH Obes Inst" <KLaschke@...> wrote: They are asking you to either do 6 months or diet education and weight loss with the patient or the patient needs to provide documentation of doing that elsewhere. We have a number of different insurance companies that look for 3-12 months of documentation so we have the patients come back monthly for the required time to meet with RD and PT to discuss diet and activity changes and we have no problem getting them covered after that (even if the patient does not really make any progress)! Hope this helps Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135 -----Original Message-----From: [mailto: ]On Behalf Of kimbo083Sent: Tuesday, August 07, 2007 1:02 PM Subject: BCBS Insurance BCBS typically requires 6 months of diet documentation. Apparently we are having problems getting a lot of these patients approved for surgery with BCBS even when they have 6 months of diet doc. I always see a patient for a nutrition consult where I review their diet history, weight history, medical history, exercise as well as give patients information regarding pre and post op dietary/exercise expectations. I always review the behavior changes that are necessary for success with the lap band. If I feel the patient is not prepared I will schedule a f/u appointment to make sure the patient is on track before surgery. Apparently, from what the insurance coordinator is telling me, this isn't good enough?!? I feel like I am providing all the right information for the patient and I use my discretion along with the psychologist to decide whether the patient is prepared and ready for sx. Does anyone have problems regarding this? I'm not sure what to do regarding these patients anymore?!? Thanks! IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature. Sick sense of humor? Visit TV's Comedy with an Edge to see what's on, when. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2007 Report Share Posted August 7, 2007 Typically the insurance company will have guidelines regarding the needed documentation. From my experience they need monthly one on one visits that discuss behavioral changes, exercise, behavior modification, weight, height, and blood pressure. They like to see that the person has exhausted all means of weight loss and that surgery is the last resort. Also, they want you to put the person on a VLCD. I always require daily food and exercise logs because they can submit that to the insurance company as well to show their progress. At each meeting it is important to weight and take the patients blood pressure. Hope that helps. Arini <tarini@...> wrote: I am so glad this subject was brought up. I work in a diabeteseducation center as an educator, but since I am the RD, I see manypatients considering gastric bypass and do the 6 month documentation. What ARE they looking for? Is there a check-list or something I shouldinclude in my documentation so that these patients won't be denied? Thanks Arini, RD,CDRegistered DietitianUnion Hospital Diabetes Education Center1530 N. 7th Street Suite 503Terre Haute, IN 47807(812) 238-7577 >>> kimbo083 08/07/07 4:01 PM >>>BCBS typically requires 6 months of diet documentation. Apparently weare having problems getting a lot of these patients approved for surgery with BCBS even when they have 6 months of diet doc. I always see a patient for a nutrition consult where I review their diet history, weight history, medical history, exercise as well as give patients information regarding pre and post op dietary/exercise expectations. I always review the behavior changes that are necessaryfor success with the lap band. If I feel the patient is not prepared Iwill schedule a f/u appointment to make sure the patient is on track before surgery. Apparently, from what the insurance coordinator is telling me, this isn't good enough?!? I feel like I am providing all the right information for the patient and I use my discretion along with the psychologist to decide whether the patient is prepared and ready for sx. Does anyone have problems regarding this? I'm not sure what to do regarding these patients anymore?!? Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2007 Report Share Posted August 7, 2007 Pts who lose wt during this 6 mo period so BMI is less than 35 may be denied. It's a tightrope. Also, it may not be the insurance coordinator's fault (prior e-mail). Sometimes insurance companies won't say what they want; only that you haven't sent adequate info.... A. Quinn, MA, LD, RD Salem Hospital P. O. Box 14001 Salem, Or 97309-5014 503-561-1109 Pager: 40678 FAX: 503-561-4721 >>> " Arini " <tarini@...> 8/7/2007 1:10 PM >>> I am so glad this subject was brought up. I work in a diabetes education center as an educator, but since I am the RD, I see many patients considering gastric bypass and do the 6 month documentation. What ARE they looking for? Is there a check-list or something I should include in my documentation so that these patients won't be denied? Thanks Arini, RD,CD Registered Dietitian Union Hospital Diabetes Education Center 1530 N. 7th Street Suite 503 Terre Haute, IN 47807 (812) 238-7577 >>> kimbo083@... 08/07/07 4:01 PM >>> BCBS typically requires 6 months of diet documentation. Apparently we are having problems getting a lot of these patients approved for surgery with BCBS even when they have 6 months of diet doc. I always see a patient for a nutrition consult where I review their diet history, weight history, medical history, exercise as well as give patients information regarding pre and post op dietary/exercise expectations. I always review the behavior changes that are necessary for success with the lap band. If I feel the patient is not prepared I will schedule a f/u appointment to make sure the patient is on track before surgery. Apparently, from what the insurance coordinator is telling me, this isn't good enough?!? I feel like I am providing all the right information for the patient and I use my discretion along with the psychologist to decide whether the patient is prepared and ready for sx. Does anyone have problems regarding this? I'm not sure what to do regarding these patients anymore?!? Thanks! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2007 Report Share Posted August 7, 2007 I am so lucky to have an insurance coordinator on staff as part of our bariatric team. Many insurance companies are now requiring diet hx- thank God I do not have do the Monitoring," as most of the insurance companies want the supervised weight loss program to be with their PCP. Fod example, GHI wants the actual doctor notes, along with the letter from PCP. The 6 months must be consecutive... we just alert patients when we receive their application that this is what thet have to do.Again, my insurance coordinator is always on top of any changes in the requirements for each insurance & she will provide a sample letter for the doctor. She know what the insurance co. want. Angie , MEd, RD, CDN Nutritionist SIUH Center for the Surgical Treatment of Obesity 256 Mason Avenue Staten Island, NY 10305 718-226-1265 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 7, 2007 Report Share Posted August 7, 2007 In our experience the insurance companies utilize the patients beginning BMI even if they drop below 35 they do not cancel approval or surgery. Crandall, RD Sparrow Weight Management Center East Lansing, MICATHERINE QUINN <catherine.quinn@...> wrote: Pts who lose wt during this 6 mo period so BMI is less than 35 may bedenied. It's a tightrope. Also, it may not be the insurancecoordinator's fault (prior e-mail). Sometimes insurance companies won'tsay what they want; only that you haven't sent adequate info.... A. Quinn, MA, LD, RDSalem Hospital P. O. Box 14001Salem, Or 97309-5014503-561-1109Pager: 40678FAX: 503-561-4721 >>> " Arini" <tariniuhhg (DOT) org> 8/7/2007 1:10 PM >>>I am so glad this subject was brought up. I work in a diabeteseducation center as an educator, but since I am the RD, I see manypatients considering gastric bypass and do the 6 month documentation. What ARE they looking for? Is there a check-list or something I shouldinclude in my documentation so that these patients won't be denied? Thanks Arini, RD,CDRegistered DietitianUnion Hospital Diabetes Education Center1530 N. 7th Street Suite 503Terre Haute, IN 47807(812) 238-7577 >>> kimbo083 08/07/07 4:01 PM >>>BCBS typically requires 6 months of diet documentation. Apparently weare having problems getting a lot of these patients approved for surgery with BCBS even when they have 6 months of diet doc. I always see a patient for a nutrition consult where I review their diet history, weight history, medical history, exercise as well as give patients information regarding pre and post op dietary/exercise expectations. I always review the behavior changes that are necessaryfor success with the lap band. If I feel the patient is not preparedIwill schedule a f/u appointment to make sure the patient is on track before surgery. Apparently, from what the insurance coordinator is telling me, this isn't good enough?!? I feel like I am providing all the right information for the patient and I use my discretion along with the psychologist to decide whether the patient is prepared and ready for sx. Does anyone have problems regarding this? I'm not sure what to do regarding these patients anymore?!? Thanks! Quote Link to comment Share on other sites More sharing options...
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