Hello! I am curious about others' experiences in regards to what role your general doctor played in you getting banded and the whole insurance struggle. In my case, my insurance company and the bariatric program at the hospital need about 5-10 years of medical records showing my weight struggles, which i doubt is uncommon. I called up my doctor and explained to her about the surgery, and then talked to their medical records person about sending the needed info. to the insurance company. They called the insurance for me and found out the specific info. they needed. I told the medical records lady all the personal info. she needed to send off to the insurance company and all seemed to be going smoothly. Then a few hours later, i got a call back from the doctor's office saying that my doctor needed to speak to me before she could write the letter to the insurance company, they did not specify exactly why.....

Well, with that all being explained I am wondering what you all think of this, and what was your general doctor's role in your band journey???? Thank you!!!! :Banane56:

Hey girl,

My doc had to alos write me a letter of recommendation along with the weight history. I am sure she just wants to make sure you know what you are getting yourself into.. So don't sweat it. So just get ready for the ride, there are alot of hoops to jump though and sometimes its discouraging, but it will happen.. Good luck to ya and keep us posted...

:Banane56:

My primary care had to authorize the codes that the hospital program used to get BC/BS to pay for everthing (just like he does when I see a specialist-his secretary or nurse actually inputs the codes-don't even know he knew a thing about it till I told him-then he got a letter from the surgeon explaining it all) I just told him I was doing it after I checked with my insurance co to see that they covered and what the criteria was. If he didn't agree it would be time for a new primary care physician for me!

But my weight history for the last 10 years? That would be tough since I've moved twice and didn't go to the doctor that much. What a pain. These insurance companies really make you go through hoops. I can understand the weight and BMI criteria but that should be it.

I wish you lots of luck!

My PCP's role was to give me a physical and write a letter supporting my medical qualification for bariatric surgery. She'd been treating me for several years and so was able to substantiate my various efforts to lose weight.

My OB/GYN helped too, in that she gave me copies of several pages of her notes taken during my two pregnancies. Basically it was to support the claim I was making to have been obese for many years. She didn't have to write anything, just copy a few pages from my records and give them to me. I sent them to the insurance carrier.

My PCP had nothing to do with my surgery. I went for a consult with my bariatric surgeon and had surgery 5 weeks later without the assistance of my PCP. I did not even deal with my insurance company (United Health Care), Dr Cribbens office did all the work. No problems at all. Guess I am lucky.

My PCP didn't think I needed the surgery! He said I should watch what I eat and exercise...I asked what he thought I had been doing for the last 40 years. He would not commit to writing a letter for me. I just went through the lap band Doc. I had to get paperwork from the PCP's office, DR notes from the last 5 years, and I took them to the lap band Doc, they sent them into insurance. Everything went through just fine without PCP! Needless to say I set up an appt. with a NEW PCP!!! He seems very nice and was excited about my surgery. I saw him 2 days after my surgery. If they aren't with you, you don't really need them, IMHO. The lap band Dr. told me all this at the first lecture that I went to. Good luck!

Carol--even though your PCP did not support your decision, was he still willing to send in the needed paperwork to your lapband doctor??

I am still wondering why the doctor requested to see me...maybe she has to give me a physical, I just hope that she is not hoping to talk me out of it...I know that my PCP knows rather little of this surgery... I am also questioning her wanting to see me, b/c it is about 1 1/2 hours drive for me to the office...

Hey Veggie, I go to a very large Dr.'s office. I didn't need anything from my Dr. just had to go to the filing office and put in a request and then pick it up a few days later. The Dr. probably just wants to talk to you about the surgery and maybe a physical, depends on how long it has been since you had one. If the Dr. does try to talk you out of it, stick to your decision. They just have one oppinion and if they haven't been through this or aren't sympathetic to the problems of obesity, get another Dr. that does!! Maybe you could call first and try to find out why the Dr. wants to see you since you are so far away. It might save you a trip. Good luck!

Hello,

Since my insurance has only recently accepted weight issues to be health issues, they didn't require medical necessity from the PCP...but they did require that the PCP send a letter that stated that per my history--I would be safe to have surgery. Which she very sweetly approved. I actually laughed at her because i was ready for the fight ....she just said we want patients to lose weight, sometimes the risk of obesity outweighs the risk of surgery. My letter of medical necessity came from the barriatric doc (as he is the specialist). But I am seeing the more I read these threads...every doc is different on their personal view of what is required and what isn't.

Best Wishes!

:faint: Hi. My PCP reluctantly said she'd write a letter if need be, but isn't too thrilled. I tried to explain that I'm running out of options here. I like her alot, she's only a few years older than me, has 2 young kids, and she weighs probably 90 pounds, like she'd understand what kinda uphill battle I'm going thru!

my case no role, really. I had to submit a physical with my paperwork, so I went to her for that, and while there asked if she would submit something supporting, just in case my insurance company wanted it (which they didn't)... so she just gave me a copy of her medical dictation and told me to let her know if I needed anything more extensive.

I have a kind of customized PPO, so I didn't need a referall, recommendation, etc. If my surgeon could have done the physical, my doctor would have been completely out of the loop, so to speak.

I'm glad I brought it up to her though. She was excited & told me I would be the perfect candidate for it. Ends up she has about 6 or 7 other LB patients. She had lots of advice to offer around the skin issue, and ways of getting PS covered through my insurance, counseling me re: ideal weight, etc. Plus she did a lot of things proactively, like give me a prescription for liquid anti-nausea medication, offer to give me a 2nd rx for hydrocodone if my original ran out and I was still in need, make sure I knew I could stop by and weigh any time I wanted, etc. She's actually been a wonderful source of support & information.

My PCP didn't have to do anything to my knowledge. She knew about it because I told her I wanted to work with a Bariatric Center but I haven't even seen her since February.

I never even told my Dr. I was thinking of getting banded, matter of fact I JUST told them last week I even had the band!

Nana~

In Australia, you need to get a referral to any sort of specialist from your general practitioner so that you can get your Medicare rebate - we get 85% of the scheduled fee of most medical costs back from the public health system.

So the GP's role is to refer you - that may occur in a situation where a GP raised the issue of his patient's weight and suggests banding or like me, when I went to the GP and said "I want a referal to a lap band surgeon". I knew who I wanted to see.

The GP may or may discuss the pros and cons of banding, but on the whole its not their business or role, and its not up to them to agree or disagree with the procedure, that's up to the surgeon, so the GP will generally refer anyone who asks.

Other than that, well it depends on people's individual relationships with their doctors but there would be absolutely no need for a GP to be involved. I have to go back and renew my referral to my surgeon as its expired after 12 months, but other than that I wouldnt even mention my band to my GP unless it happened to be relevant to a problem I was seeing him for.

I got copies of my records from my PCP and brought them to my consultation. These records are where I had documentation of my medically supervised weight loss program. I did not tell my PCP why I needed the records. I turned them in at my consultation, and they took care of everything with my insurance company, and 3 days later I was approved.