I went to my third visit with my PCP (6 month diet) and he told me today that he thinks I should just try to loose the weight on my own again and is not going to submit anything to my insurance company at this time. I guess I am going to need to go find a new Dr that will back me on my decision to have WLS. He has been my Dr for over 10 years now. This really really sucks!

You are so right, that SUCKS! The problem I have with that is that he should have been up front with you about it in the beginning! Will you have to start over or will they allow you to change physicians mid-stream? Good luck to you!

I dont know, I am so worried that I will have to start over but I guess I will have to call Health Alliance tomorrow to find out. Why couldnt he just tell for from the start that he wouldnt back me. I am also thinking that I might just call the clinic and tell them to send my insurance company my records anyway. At least they could tell me if I will even qualify or not. They do cover it, just dont know if they will approve me or not.

I'm so sorry---that really does suck! Did you question his reasoning? Are you losing that steadily that he thinks you can do it?

What are your stats----how much do you have to lose? I was wondering if you are close to the cut off or what.

I too would be looking, and quickly so maybe your 6 months does not get interupted. What a jerk!

Hang in there!

Kat

Quincy Girl, are you in Massachusetts? If you are, try the program at Lahey Clinic in Burlington, Mass. It is extraordinary and they really help you qualify with insurance companies. The program they offer is tremendous. Good luck to you. Michele

I am in Quincy IL. My current weight is 226 and I am 5'3.5". I am not currently loosing weight but I did do it before. I had lost 70 pounds and have put back on 46 pounds of it. I feel like such a total failure because of it. I do not have high BP or Diabetes but I do have stress incontinance, GERD and irritable bowel syndrom as well as painful joints. I am soooo hoping to find someone to help me. Thanks for the replys.

Edited April 3, 200818 yr by QuincyGirl

Quincy Girl, have you been to Lapband group sessions at a local hospital? You should check there and see if a doctor who believes in and supports this decision will take you on as a patient. Perhaps you could just be completely candid with your PCP and ask him to refer you to someone who will guide you through this procedure. It may seem bleak right now, but keep trying!!!

You know what burns me up is that Dr's are employed because "WE" go to them. Do they understand that they are there for us.. not for what they think... no one pays them to think... the point is, is that you are capable of loosing it but why do u have to go thru all of that again. That is what the lap band is for. That is the very reason why i got a ppo so i would not need a referal from any primary Dr. at all... Do you have an hmo or ppo?

I was close to the cut off too. I had to gain a couple of pounds to reach the 35 BMI but I have a lot of other health issues that helped me qualify quickly with my insurance company. Ex. High cholesterol for over 10 years. Beginning of very high blood pressure, Back pain from a fractured vertebra from 10 years back, stroke and heart disease in my family. If you are close to the BMI limit of 35 - 40 with no medical reasons, it is tough to get insurance to pay for it. If you meet the criteria, it should be a breeze for you and you should get another opinion.

I saw a Dr. that was close to where I live and they had me hang on for 60 days to become a center of excellence so my insurance would cover 1/2 of the cost, instead of just $1,500. They finally told me it wasn't going through as quickly as they thought. They had the approval for center of excellence but the red tape was slowing the process down so they referred me on to another Dr. about 15 miles away, who was able to take all my records and I met with him once and we scheduled surgery together within a few weeks, since I was already pre-approved and had all my before surgery stuff done!

Don't give up. Just work through this another way to make sure your getting the right opinion from your Dr. or he isn't as sensitive as he should be to you. Hope the experiences and advice helps you. Don't give up yet. Good Luck!

You shouldn't have to start over. I had a couple months from my PCP records but I did most of my 6 month with my lap band surgeon's office. With my insurance it just had to be a doctor documented attempt.

Not sure what you mean by PCP but when I went to my GP to get a letter stating I needed the op, he did it but said that if insurance companies etc decide later on that you didn't need the op they can sue the Dr to get their money back because the Dr said you need it.

This is in Australia though but it'd be interesting to see if anyone else was told this.

I have a HMO plan. I will let yall know how things go tomorrow. I am calling Health Alliance to see what I can do at this point. Thanks for careing. Oh, a PCP is your Primary Care Physician.

Bless your heart that really does suck! I didn't go through my pcp I went to a physicians weight lose clinic and the doc there wrote my letter. My pcp didn't want anything to do with it because I was going through this diet program. Good-Luck to you! Don't give up!!

I am so sorry you invested 6 months to be denied! Doncha just hate the hoops you have to jump through because of insurance? I am in an HMO and have to get referrals to go to a specialist like a bariatric MD. I kind of got lucky--I called my PCP's office and asked to speak to the referral nurse and explained I had been to a seminar and met the preliminary criteria to get a lap band and now I needed a referral from my PCP for insurance purposes, and she sent it right through without making me come see my PCP first! I'm afraid that if I saw my PCP first he also wouldn't want to send me to a bariatric surgeon...they don't even recommend diet pills there!

I'm sorry that you're going through this. You'd think that if he wasn't going to support this he wouldn't have had you go through all you did!

I'm hoping I don't have a problem. My PCP referred me on to the seminar to get in the program and has done the referrals for the nutritionist and psych eval and then I found out he was switching departments and wouldn't be here to send the final application to the surgeons once my reports were back to him. My new PCP starts at the end of this month and I'm worried about having to fight him over this. My PCP assured me that it would be okay w/the new PCP and I'd like him but we'll see. I'm not going in expecting problems but will not be too surprised if there are problems.

I think it's all about rich insurance companies setting the standards for us to be so overweight before they will pay for it that we have seriously risked our health. Personally, I scraped together $8,000 and have booked an appt. with Dr. Ortiz in Mexico and I fly down there May 7. Why can't someone opt to have this done when they are 60 or 70 lbs overweight? Why weigh a ton and be almost dead to get it. It sure does suck!