Question:
I have a problem..

I have a problem. I was preapproved for surgery in August. My bariatric nurse sent papers to my family doctor to fill out. Apparently they just filed them and did not fill anything out. Now they are saying they are having trouble coming up with 5 years of medical neccessitey problems. I do not have high blood pressure, diabetes or anything like that. I have back aches, feet hurt and depression because of my weight. I am pretty bummed out over this now because this could be something that will hold me back. I have already spent $500.00 on different things my insurance required such as dietician and behavioral classes. What can I do to convince my family doctor that it is medicaly necessary? I just feel like I am not winning here. Any ideas, this is something I really need and want.    — missyheffelfinger (posted on October 6, 2006)

October 6, 2006
See what your insurance company requires. Most don't require 5 years fo medical neccessity problems, just 5 years of a BMI over 40 if you have no co-mobids, or a BMI of 35 with 2 co-mobids. I woudl find out what they require. Best of luck. LOL jen
   — jlflbf

October 6, 2006
Missy, I was worried in the beginning too. I made it very easy for my Doc. I wrote the letter of necessity myself. It was so easy for him that he just told his girl to transfer it to his letterhead, and he signed it. She sent it to my surgeon along with my medical history of over 10 years and I was approved same day. If you would like a copy of the letter I did, email me and I will send it to you on Monday. I am not sure about any other forms that you are speaking of, unless it is the 6 month observed dieting. how long have you been seeing your pcp? email me at [email protected]
   — dessary316

October 6, 2006
Missy what is your BMI if you dont mind my asking ? What insurance do you have? Some insurance companies dont require a 5 year history. And as far as your PCP doctor not thinking it is medically nessary for you to have this surgery then I would be looking for another doctor. Let me know if you have any other concerns maybe I can see if I cant help ya... Lesa S - Tx
   — Lesa S.

October 6, 2006
Missey, sorry to be the bearer of Bad News BUT we've all gone through this. First check as suggested with your insurance as to what is required , to make sure your policy even pays for any of the surgeries and what test & records they want. Get a copy for your records on paper. Second make sure your Primary is WLS Friendly, once you meet your insurancee requirements as well as any others your primary which gives to the referal to the surgein & medical clearence for the surgery-will they refer you. IF Not you need to find another Primary. Third pre-approval - Who gave you preapproval? The Surgeon's staff. Any paper work except to your insurance company, you want a copy for your records. So to better make sure who gets what and no mistakenly misplaced. Be your own courier and make a list of who got what and have whoever sign a list saying who received it at what office. 5 years of Mecial History - Do you have these records yourself, have you've been seeing this Primary for five years iif not go get your records from the Doctor before this one and so on plus any Medical Tests within the last 5 years. Document everything. What is the required BMI by your Insurance for WLS - or most it's 35/38 with co-morbilities - 40 with just being healthy but Fat. If you really Want this you need to grow Patients, as I did. It took me two years from start to receiving my RNY Gastric Bypass, but it was well worth the waiting, strugling, headaches, stupidity of others, exhaustion and wanting to just give up!
   — Michael Eak

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