What to ask my doctor when talking about WLS?

[Tierra T Tij 56]

Okay, so I have an appointment with my doctor on March 31st 2016. I am going to ask her if she could refer me to my old WLS team to get the gastric bypass. Note: I have been trying for almost close to 3 years to get this done, tried it seems everything to try to lose this weight and so far I've had set back after set back I'm trying to be more positive and buckle down and just do this because I need to lose weight not only for health reasons because I have a physical disability and with my weight being this high it's hard to walk most of time. I cannot sit or stand for long periods like no longer than 5 minutes it sucks because I'm trying to get a job but I don't think there will be any job for just 5 minutes. Anyways, I wanted to know what should I ask my doctor and how should I tell them I REALLY want to get the gastric bypass and how do I go about referrals?

[2goldengirl 2,076]

At your height and weight, you meet the BMI criteria for surgery for most health plans. Who is your insurance? Who is your medical group?

[mngreeneyes 674]

My insurance didn't require a referral for WLS, but I eventually had to have a note from my PCP as one of the hoops. I knew I would get it because i had already talked to my PCP about the surgery, but I didn't need to do it before I started the process.

Best wishes,

pam

[Tierra T Tij 56]

Okay, thank you

[Tierra T Tij 56]

• 2goldengirl, I'm 5'4 and weigh 303, I have dual insurance with Partnership and Anthem Blue Cross and my medical group is Sutter Medical Foundation.

[katanne 215]

I'm also afraid my PCP won't write the required letter for my insurance. But if you're clear about the ways your weight is affecting your health, and that you know what the WLS process entails, it's very likely you'll get the referral. Of course I have to keep reminding myself of this as well!

[2goldengirl 2,076]

• 2goldengirl, I'm 5'4 and weigh 303, I have dual insurance with Partnership and Anthem Blue Cross and my medical group is Sutter Medical Foundation.

Partnership is Medi-Cal, isn't it? , Anthem Blue Cross' medical policy is available online: https://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm

If you are Medi-Cal with Anthem Blue Cross, that isn't dual insurance, it's just Blue Cross Medi-Cal. Just tell your PCP you're interested in bariatric surgery. Everything for Medi-Cal requires prior authorization. You will also need a psychological evaluation and a visit to a Registered Dietician.

You will need to show documented participation in a weight loss program for at least six consecutive months within the past two years. If you already have done that, great, you're ahead of the game. if not, be prepared to visit your PCP monthly for six months. Your PCP will need to document that they gave you guidelines for both diet and activity, it isn't enough to just have weights done.

You can call Sutter Medical Foundation and see whether they assign a Case Manager or Coordinator for their members seeking bariatric surgery. Good luck!

[CowgirlJane 14,261]

After having the same primary doc for 10years...I tend to hang on too long...it was remarkably easy to replace her when she didn't support WLS and in fact displayed a general ignorance and unwillingness to listen. She hadn't even heard of the sleeve... made me wonder if she kept current with modern medicine at all.

Your BMI is 52, which is considered high ( mine was 52 also). An outstanding bariatric practice with good results, ongoing support and education and a billing staff that knows how to work with insurance is way more important than primary doc on this subject. Don't expect your primary doc to be that we'll informed.

My initial info was from my sleep apnea doc. First doc that had the guts to tell me, in a compassionate way, that I was dying prematurely. He had good knowledge of the obesity disease process and why I was beyond"diets"

and needed WLS. After i got to goal I mailed him before and after photos and wrote him a letter of thanks. His prodding me to have an open mind saved my life.

[SillyOleMe 32]

I have never had a primary Doctor I hate going to them a thankfully I'm very healthy besides being very overweight. I found the surgeon I wanted and they actually referred me to a primary in the area that they work with and of course is WLS friendly to help me with my insurance hoops! Now he has agreed to write my letter and I'm just waiting to hear back from the office! maybe that's a route to try?

Sent from my iPhone using the BariatricPal App

[Tierra T Tij 56]

CowGirlJane, I have sleep apnea, have trouble sleeping at night because it feels like my body is crushing itself and type 2 diabetes. I've tried everything and it seems nothing seems to help me lose weight nor make my pain from my foot injury any better. In matter of fact, I have a hard time walking due to my foot injury and my weight and gained 100 pounds because of it. So I hope things go well, thanks....

[2goldengirl 2,076]

After having the same primary doc for 10years...I tend to hang on too long...it was remarkably easy to replace her when she didn't support WLS and in fact displayed a general ignorance and unwillingness to listen. She hadn't even heard of the sleeve... made me wonder if she kept current with modern medicine at all.

Your BMI is 52, which is considered high ( mine was 52 also). An outstanding bariatric practice with good results, ongoing support and education and a billing staff that knows how to work with insurance is way more important than primary doc on this subject. Don't expect your primary doc to be that we'll informed.

This is California. The OP is in a Managed Medi-Cal plan. She has to start with her PCP, that's how it works under these circumstances. It's no biggie, I've had several clients who were referred for WLS by their PCP's on their initial visit to them. I know Dr. Shadle's work and both the hospitals where he does surgery and all should be good there.