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How to get my PCP to referral me for weight loss surgery.



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I want to get weight loss surgery but my PCP won’t approve. I’m currently 294 with a height of 5 feet. They tell me no because I have no comorbilities. Does anyone have suggestions?

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Which country are you in? Most countries/insurance provide for BMI 35+ with co-morbidities or BMI 40+ without co-morbidities. Your BMI is greater than 40.

Do you have the option of finding a more supportive doctor?

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I currently live in Texas. I need a referral in order for Medicaid to consider it; since I don’t have private insurance. According to Medicaid it has to be a medical need.

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What type of health issues are they looking for? High blood pressure, cholesterol issues, diabetic or pre-diabetic, sleep apnea, fatty liver?

You don't have any health issues at all?

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I was at the same point last year and went in for a sleep study. I barely qualified for a CPAP but insisted they put me on one. That was all I needed. I had weight and breathing. Medicare covered the surgery and the sleep issues. Now I'm off the machine.

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I don’t. He did lab work and a complete scam and he said I’m healthy. I just need to lose weight. He said I should be able to accomplish by diet and exercise. But in the last 6 months I have gained over 40 lbs and I’m very stressed.

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8 minutes ago, marti33m said:

I don’t. He did lab work and a complete scam and he said I’m healthy. I just need to lose weight. He said I should be able to accomplish by diet and exercise. But in the last 6 months I have gained over 40 lbs and I’m very stressed.

Can you switch doctors? He's wrong. Is we could lose weight with diet and exercise we would have. Only 5% of people can keep it off long term.

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When you're overweight a great deal you almost always have sleep apnea it goes hand in hand. I told my doctor that I was always tired, getting up often to pee, and falling asleep during the day. Then I insisted on a referral for a sleep study. First, they did a home one, which showed I had issues, then I did one in office. My issues were such that it was border-line and so I insisted on a machine. If your current PCP is not willing to work with you change. Mine saw the difference that it could make as his MIL had the surgery. Just keep trying if one door closes then go to another. The doctor that did my WLS was the one that put the lap band in and took it out. He also was a big help. Don't give up! The world is full of doctors who are more knowledgeable and helpful than the one you are seeing now.

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Thank you for the advice. I’m going to change because I really need this surgery. I’m going to request a sleep study and hopefully it gets approved.

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With your BMI, you shouldn't even need a sleep study. Like others said, just find a new PCP! Good luck!!

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15 minutes ago, ChubRub said:

With your BMI, you shouldn't even need a sleep study. Like others said, just find a new PCP! Good luck!!

Facts

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Posted (edited)

2 hours ago, ChubRub said:

With your BMI, you shouldn't even need a sleep study. Like others said, just find a new PCP! Good luck!!

the OP will probably need one regardless. Not because they might possibly need to list it as a co-morbidity - at that BMI, they won't. But they need to know if a person has sleep apnea before a major surgery - the anesthesiologist will need to be aware of it.

Edited by catwoman7

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You definitely need a new doctor. Your BMI calculates to 57.4 and you shouldn't need ANY comorbidities with that BMI. Good luck!

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7 hours ago, catwoman7 said:

the OP will probably need one regardless. Not because they might possibly need to list it as a co-morbidity - at that BMI, they won't. But they need to know if a person has sleep apnea before a major surgery - the anesthesiologist will need to be aware of it.

My surgeon wanted me to have a sleep study but insurance denied it so I never did it, we just moved on.

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