Revision, Proof of medical necessity for 1st surgery

[CristyA]

My insurance is asking me for proof that my initial surgery was medically necessary under their current criteria for WLS. I had my 1st surgery in Mexico 13 years ago without insurance. I don't have my surgical records. I have contacted my surgeon but I don't know if he keeps records for over 13 years. The family doctor I was seeing at the time here in the US has moved and he is proving hard to find so I don't have my medical records which could show my weight and weight loss attempts during that time.

I will continue to try to get the information they are asking for but in the meantime any advise would be great! What if I can't find it? Thank you.

 

[DianaCox]

Photographs from the time, medical records from a different doctor?

 

[hilary1617]

Any past hospitalizations? Records from gym memberships or diet programs?

 

[Larra]

Is such proof actually a stated requirement in your policy, i.e. in the EOC (Evidence of Coverage, a lengthy document that sets out all the criteria for bariatric surgery and all other covered services)? Get your EOC and see if they are even asking for something that is required. And if they are, and you just can't get anything else to prove your past medical necessity, maybe notarized statements from people who knew you back when, such as parents, siblings, employer, whoever you can round up.

 

[CristyA]

Thanks for replying! I called my insurance a few times and it took them about a month but now I have the approval and the surgery is scheduled for the 16th of this month

 

[Larra]

That's great news! Keep us posted as you move forward, and ask questions if you need to.