Hey Guys,

So I had my first appointment with my surgeon on Monday it went great, they set me up with all my appointments and told me if everything went well i would have my surgery by ending of October beginning November. I was super excited UNTIL today. I went to my doctors office to get some more referrals i needed and asked him for the Medically Necessity letter and he said NO. He needed to observe me for an addition 6 months. I can't believe not even my insurance is asking for that much time. Does anyone have any advice, please help.

Did you ask him why 6 months especially when it’s not something needed. How often have you seen him this last year?

I noticed you had this question posted on another forum. I'd listen to Green - follow up with your surgeon.

But, I'd ask you this first. Had you spoken to your doctor in the past of getting help with weightloss? Had you been on a dr. approved plan prior to speaking to your surgeon?

For me personally, getting my PCP referral was easy because my PCP and I had focused on weight management for 3 years and little success. So when I went to her for a referral letter after seeing my surgical group it was an easy referral as there was documented failed weightloss attempts with her practice for more than the required time.

Can your PCP some how be liable for any reason? I was not in any kind of weight loss program. We had discussed weight loss and she mentioned once WLS but I told her I was not interested. My brother had a band some years ago and it was a failure. A year or year and a half later and I was getting VSG. When I asked her for the letter she had no problem writing it. I don't get why a Dr would make you do a program under their supervision unless somehow they could get screwed for some reason.

Find a new PCP. My old one said no to all WLS, and tried to scare me out of it with fear tactics. I found a new PCP that was very knowledgable and supportive.

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On 9/13/2018 at 7:51 AM, MargoCL said:

I noticed you had this question posted on another forum. I'd listen to Green - follow up with your surgeon.

But, I'd ask you this first. Had you spoken to your doctor in the past of getting help with weightloss? Had you been on a dr. approved plan prior to speaking to your surgeon?

For me personally, getting my PCP referral was easy because my PCP and I had focused on weight management for 3 years and little success. So when I went to her for a referral letter after seeing my surgical group it was an easy referral as there was documented failed weightloss attempts with her practice for more than the required time.

I agree with this. it was my PCP who started me on the path to WLS and straight told me that she would write a letter of medical necessity if I needed one. This was after almost 5 years now of attempts under her supervision using various dieting, appetite suppressants and pills that turn your poo to grease, etc. How would you start this process by not consulting with your PCP first, that seems unusual to me, no offense?

On 9/12/2018 at 10:31 PM, Yessican said:

Hey Guys,

So I had my first appointment with my surgeon on Monday it went great, they set me up with all my appointments and told me if everything went well i would have my surgery by ending of October beginning November. I was super excited UNTIL today. I went to my doctors office to get some more referrals i needed and asked him for the Medically Necessity letter and he said NO. He needed to observe me for an addition 6 months. I can't believe not even my insurance is asking for that much time. Does anyone have any advice, please help.

He doesn't have the legal right to do that, if insurance isn't requiring it... then he has no right to say so. Tell him you'll go to another doctor if he refuses to provide you with what you are asking for.

48 minutes ago, Matt Z said:

He doesn't have the legal right to do that, if insurance isn't requiring it... then he has no right to say so. Tell him you'll go to another doctor if he refuses to provide you with what you are asking for.

Is that really true though? I feel like there were a lot of things that my surgeon's office required that weren't a part of the insurance requirements?

I get what you are saying though, just find a different doctor.

1 minute ago, AshAsh1 said:

Is that really true though? I feel like there were a lot of things that my surgeon's office required that weren't a part of the insurance requirements?

I get what you are saying though, just find a different doctor.

Surgeon's office maybe, because they have requirements preping for surgery, the PCP can't withhold an approval letter like that because they want to drag their feet. They aren't the nutritionist, or the surgical team, the ONLY thing the PCP needs to do is to say "So and So is healthy and has no issue that would prevent them from getting the surgery". It's a basic level, clearance check, so that the surgeon knows that there aren't any medical issues they are not aware of currently being addressed.

5 minutes ago, Matt Z said:

Surgeon's office maybe, because they have requirements preping for surgery, the PCP can't withhold an approval letter like that because they want to drag their feet. They aren't the nutritionist, or the surgical team, the ONLY thing the PCP needs to do is to say "So and So is healthy and has no issue that would prevent them from getting the surgery". It's a basic level, clearance check, so that the surgeon knows that there aren't any medical issues they are not aware of currently being addressed.

Oh shoot, I didn't read the original post correctly. My bad.

If your doctor recommended wls to begin with then he should've had no reason to suddenly change his mind. I would ask him what changed between his initial recommendation and now.

I think there are some people who don't have a PCP and go straight to a bariatric center for help.

Surgeon's office maybe, because they have requirements preping for surgery, the PCP can't withhold an approval letter like that because they want to drag their feet. They aren't the nutritionist, or the surgical team, the ONLY thing the PCP needs to do is to say "So and So is healthy and has no issue that would prevent them from getting the surgery". It's a basic level, clearance check, so that the surgeon knows that there aren't any medical issues they are not aware of currently being addressed.

My pcp had to medically clear me and notate all the weight loss attempts and failed.

I had a pcp we spoke about my weight but never put me in a supervised plan. I myself tried multiple ways to lose weight by trying Herbalife trying cabbage soup diet taking diet pills that a different dr prescribed them to me. I changed my insurance recently and now have a new pcp. I came totally not prepared when I saw my new ARN as pcp. But I scheduled with a different doctor and am collecting all my old medical records that shows my attempt with the pills, Herbalife, gym memeberships, lab works, and records that show I’ve been obese for over three years hopefully this doctor can understand ?

AND I WISH YOU ALL THE LUCK IN THE WORLD!?

He doesn't have the legal right to do that, if insurance isn't requiring it... then he has no right to say so. Tell him you'll go to another doctor if he refuses to provide you with what you are asking for.

I had a brand new primary so I got my letter from my orthopedic dr stating the loss of weight will have a positive response on the damaged discs in my back and ultimately require less medical interventions. Think about going to the dr that is treating any of your comorbidities ( cardio dr? Endocrinologist?)

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See if another doc in the same practice will sign off. That’s absurd