Question:
New Dr. says i am not obese enough for surgury
i started my journey a few yrs ago. I did everythign i was suposed to do. i got letters from a few drs. and went to the surgoen. the surgoen aproved me and sent everything including pics to my insurance company. well they denied me, so i wrote a 20 page appeal and was denied once again. well now we have a new insurance that will pay for this surgery, problem is my new dr. wants me to try all these drugs and stuff first..I have read about some of these drugs and i really don't care to take them due to the side effects. i called my surgoens office to see if he still had my file, so i could show this new dr. when i called that said they keep all files yet could nto find mine. Someone please help me. — Denise H. (posted on April 6, 2003)
April 6, 2003
Is your new "doc" your everyday doc and he is a provider that
works with your insurance or is this new doc actually a new surgeon who
does WLS? Also curious as to who said you didn't weigh enough? Is that
from a surgeon or from your PCP / everyday doc? Obviously if a surgeons
office has done all the paperwork and was working with your insurance from
before, unless something has changed (like you lost weight) things
shouldn't be any different, other than any different or additional
requirements your new insurance has.
— Shelly S.
April 6, 2003
What is your BMI??? If it is over 40...then you qualify. Tell this doctor
of yours that you do not wish to take these drugs because of the side
effects. If that does not change the doctor's mind, get a new doctor.
Remember people, your doctor is supposed to be working for YOU...and if you
don't like the way you are being treated...move on. I can't believe that
we as a society will stop going to a restaurant if we don't like the
service, but we'll continue to go to a doctor who does not want to do what
is best for us. Have a Sparkling Day!! ~CAE~
— Mustang
April 6, 2003
MY PCP also told me he didn't think I was "big" enough for this
surgery. I made sure I had done my research just in case this was the
answer I got. I told him that I knew the guide lines (telling him what they
were), the risk(naming a few), and all the options(what I've tried and how
long I'd been fighting obesity), I even gave him stats on sucess rates of
"diets", I then told him that I wanted the chance to make this
choice for myself, and that I needed his referral to be able to even talk
to the surgeon, and that I felt I was worth it. It worked! I got my
referral and I'm 2 months post op, with a PCP who is thrilled about taking
me off all the meds I was taking for co-morbids. Make another appointment
with your PCP and go in armed and ready! If that doesn't work, call the
surgeon's office and ask for a list of PCP's that are WLS friendly.
— mildstorm
April 6, 2003
My first PCP didn't believe in this surgery and also didn't think I would
qualify and/or my insurance would pay. In fact, he fired me as a patient.
I wrote a panicked post on here asking for WLS friendly PCPs in my area and
someone sent me the name of my current PCP who is an absolute doll. The
time from my first meeting with my current to my surgery was about 8 weeks.
Insurance approved immediately because my BMI was over 40. I wouldn't
horse around with a nonsupportive PCP, I'd get another one or be more
adamant with this one about not trying drugs. My current PCP did discuss
trying a few other things before surgery but I had had it with everything
and wasn't willing to do one more failed experiment. He was sympathetic.
However, it turned out (after I saw my surgeon) that I really didn't need a
PCP for anything but medical clearance so check with your surgeon as to why
you need the PCP approval and if you can't do without it, find one who is
more supportive or be insistent with the one you have.
— susanje
April 6, 2003
My PCP said I did not qualify for surgery,I switched MD's, got referred,
approved and as theysay, the rest is history!
— ~~Stacie~~
April 6, 2003
Your BMI is over 40-dump the doc and get one that has a clue!
— Kristen S.
April 7, 2003
Does your insurance require that you have a referral from your PCP to go to
the surgeon? Mine didn't and neither did the surgeon. I made the
appointment with the surgeon, his office got the insurance approval and I
had surgery within a month. If you have to have a referral, get a new PCP.
— Patty_Butler
April 7, 2003
When looking for a new PCP, I told them all that I was planning to have WLS
and I didn't have time to waste if they didn't agree with the surgery. You
have to upfront and frank. If they disagree with the surgery, check them
off you list and move on to the next! Don't waste anytime on them!
— aprilbaree
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