RLittman

Unicare has been wonderful as has Dr. Spivak's office. Unicare has given tentative approval, however, the pcp letter recommending for me for surgery is not a medical pre-op clearance. Luckily Dr. Spivak's office is working with an internist who has scheduled me tomorrow to provide such a letter, and the internist has reduced her fees significantly because she is out of my PPO network. Keep the fingers crossed!

I wish Dr. Spivak has provided a sample letter for me to take to my pcp. Luckily, pcp sent a letter supporting my surgery. He did not mention medical clearance but I realized from the one of the sample letters you all sent that I did not need such wording as long as pcp showed support for procedure. Keep your fingers crossed all goes well. :clap2:

Lo and behold my primary sent the letter out last night! He wrote that he was asked to write a letter in support of bariatric surgery for patient XXX . . ." and then outlined the medical issues I have faced. While he did not say I strongly encourage or whole heartedly endorse, it nevertheless is a letter of support. He did not write anything about clearance for surgery or approved for surgery, just that he supported my request for surgery.

This is long but bear with me. In less than 3 weeks after applying, insurance is on the verge of approving my lap band procedure but I have run into the problem I predicted with my primary care doctor. When I first approached him for his opinion, he told me he is no expert on bariatric surgeries but asked me to talk with a gastric bypass surgeon. He also expressed doubt I would qualify because he did not think I was overweight enough. I am 90 pounds overweight and have been at least that much overweight 30 out of my 46 years. I talked with the gastric bypass specialist and with Dr. Spivak who does lap band; both said I was a candidate for either procedure with a BMI of 38 because I have several co-morbundities. I applied to insurance for lap band approval but did not send an internist letter. Ins. called today and want his pre-op clearance in 3 days or they will deny. I saw my internist today who again said he did not feel I qualified because I am not morbidly obese. (I informed him I am only 10 lbs away from that category) and that he would not write a "glowing letter" to the insurance co. nor would he "clear" me for surgery because that is "up to" the anesthesologist. I reiterated that he must say I am fit for surgery not whether he feels the surgery is justified or if I am qualified from a bariatric standpoint. Having just gone through the pre-op process last week for my mother-in-law's brain surgery, I told him that the internist has to say I am fit for surgery otherwise the anesthesologist is a moot point. He then said he "may be too busy to get the letter out in 3 days" WHAT DO I DO? Should I ask the lap band surgery for a friendly internist who does not know my medical history but who can approve me for surgery? The internist at the hospital asked my mother-in-law some basic history and took her bp and that was it - she was approved. HELP!! :help: :cry :angry

Unicare requires a psych evaluation to which I must pay a $30 co-pay. Should this be done during the initial approval period to the insurance company or should I wait to hear that the insurance company approves the procedure pending the psych eval?

Thank you for the information. I have already checked with Unicare and our policy does cover bariatric surgery. Unicare requires necessary paperwork and psych evaluation.

Has anyone had experience with Dr. John F. Sweeney at Baylor in Houston? Do you know if he is a Unicare provider? I understand that he favors gastric bypass. Has anyone had a lapband performed by him? RLittman:help:

Has anyone used Dr. Spivak with Unicare Insurance? So far the only testing that Unicare is requiring is a psych evaluation to determine fitness for the procedure. They also asked for medical notes from my pcp and any other information I feel is necessary to prove medical necessity. I thought I would send them pcp notes showing high cholesterol and borderline diabetes along with my orthopedic notes showing degenerative disc disease and arthiritis. Spivak has a form that you fill out to show all the diets you have tried, and when and how much weight you have lost/regained. I go to his seminar on May 12th.

What do you do if gp will not provide letter of recommendation for lap band surgery? Even though I am 100 pounds overweight, BMI 35, borderline diabetic, degenerative lumbar discs disease, foot problems, arthritis in my back and hips, high cholesterol, my general practitioner (primary care provider) is not in favor of this kind of surgery. Insurance will wonder why the gp's letter of recommendation is missing. My orthopedic doctor supports my decision and will offer a recommendation. Any thoughts on the subject? :grouphug:

Hi there. I have researched the web and decided to attend Dr. Spivak's seminar. Plus it helps that he is on my insurance - Unicare. I'm 46, female, 5'6" and 220. I have been overweight my whole life. I am not a big yo-yoer. I have dieted successfully on my own, but always regained. In the last few years I have tried to lose but as I get older the pounds are just not coming off like they use to. I literally have to exercise the equivalent of climbing Mount Everest and back along with diet to lose 1-2 pounds a week. So here I am at the threshold and the decision seems easy - I have no doubt I want to do lap band. My insurance requires psychological evaluation - one question - if I am not depressed (and I am not since I have lived with this my whole life), but frustrated with my current lifestyle - will I still qualify? Or should I go in there boohooing so I have the depression diagnosis? I am borderline diabetic, have foot problems, degenerative lumbar discs disease, arthritis in my back and hips, high cholesterol - isn't that enough or do I need to be depressed as well? One other thing, my general practitioner is not in favor of this kind of surgery, period. He is very old fashioned about it - diet and shut up. Ins. requires that I produce my general practitioner's notes but will I need a letter of recommendation as well? My orthopaedic doctor supports my decision and will offer a recommendation. Any thoughts on the subject? Can Spivak do the letter of recommendation or will it need to be from my gp? Thanks:confused: :confused: