I have the Doctor from HELL...........I have completed all the prerequisites for appoval and the surgeon is ready to submit for approval and my PCP is standing in the way. She was with me all rhrough the process but when it came time for her to do her part ( writing the recommendation ) she refuses....saying that she does not have the time to do that, and further that my insurance co Horizon BCBSNJ doesn't pay her to do these kind of things....I even offered to pay her myself and still she refused. She faxed copies of the patient chart records tto the surgeons' office and said that he (the surgeon) should be able to get whatever he needed fron that....I have called the Ins co. myself to try and see if we can get around this MONSTER..and was told to have the surgeon get in touch with the Utilitization Dept...My question is ...have anyone here have this kind of issue and if so how did you manage it....

BTW....obviously I will change my PCP..but she has been my PCP for eight years and I don't want to change midstream....but as soon as this is approved!!!!!!!!!!!!!!!!!!!!!!

thanks Maya....this Sounds Great

as You Can See I'm Still Logged On Here Trying To Find Help...and You Came Through...thanks A Heap...i'll Probably Be Up For A While (as Usually I Am...don't Sleep Without Meds..i'll Add That Too) And Plan On Taking It To Her Office Tomorrow....

will Let You Know How It Turns Out....

oxox

wow..that is terrible...why on earth would she act like this? I don't blame you for changing doctors...I would too...

I never needed a letter from my PCP doctor. He wrote the first thing on a prescription pad, sending me to see the surgeon, (I didn't need a referal either) and then I faxed over the requirements to his office that the surgeons office required and that was it.

I don't get why the doctor gets an attitude when they were working with you through the procedure in the first place. Unbelievable.

I do understand that docs are very busy and stressed and letter writing and jumping through insurance hoops can be a pain. But GEEZ - didn't they know that going into the profession? Isn't their staff competant enough to have these types of letters ready to be tweaked and signed? To me this is just like writing you a prescription! Your RX is medically necessary just as your WLS is, or your surgeon wouldn't be doing it. Perhaps writing a letter to the insurance company to complain about this might also make you feel better. Is your doc in private practic, or is this a partnership. Do all of the partner's have the same policy? Hang in there, you will find a way around this, and look back on it later as just a bump in the road!

shorty, stay strong and be encouraged. Over 2 years ago my pcp did similar to yours. She sabotaged my attempt at surgery during my weight loss trial for insurance. 3 months in, I had lost 22lbs (most of it water weight, from cutting out soda etc...) and she decided if I stuck to the diet I could lose the weight, no surgery needed. She told me she wouldn't recommend the surgery, and blew my hopes out of the water.

I got depressed, gain back all the weight I'd lost plus some more, and figured I was screwed. Then I changed pcp's, and my surgery is now in June.

Don't waste time on depression or feeling sorry or upset. Simply switch pcp's. Get all your documentation sent over to your new pcp, and have them write the letter. The letter from the new pcp and included documentation will prove you've done the weight loss trial period, and completed all you need to do. The insurance should still accept it, mine did. Good luck!

-Brian

She sounds so mean! I would try your OB/GYN. Mine said if I had any problems with my PCP he would do whatever I needed. Good luck!

I told my PCP they might request a letter from him, but when I went to my Ob/Gyn, she was so excited about me having surgery that she actually asked me what I needed my record to say should they request it! So we went over a few things and when I went back to my surgeon's office, I told them by all means, to request my record from her!

I can't believe your PCP is so into herself! Glad you are changing and hope you can get over the hurdle. Good luck!

I typed out my letter and took it to my Dr, had her copy it on their letterhead and sign it. I scheduled an appt specifically for that.. figured since I paid the copay.. she was getting paid to do it. That's what worked for me.. Good Luck.

What ever happened with this?

Hey All,

I have been talking with my ins. co. (Horizon BC/BSnj)...and letting them know what is goingn on...they have instructed me to have the surgeon's office to submit my case as is...and they will have the Bariatric Nurse take over my case...unfortunately...my co-ordinator at the surgeons office was on vacation last week and her assistant seem in a fog as to how to put it together.....I will be on the case first thing on Monday....will keep you abreast on how things progress..

Shorty184

Goodmornig All,

So let the games begin.....I call the surgeons's office this morning (10:15) and was ,you guessed it, dumped right into voice mail...I'm beggining to get the feeling that maybe I need to reqroup with a new team and start all over again.....this drs. office does not rank in the top on answering and returning calls...as if I need this coupled with the issues with my PCP....well we"ll see...I be back

Shorty

Goodmornig All,

So let the games begin.....I call the surgeons's office this morning (10:15) and was ,you guessed it, dumped right into voice mail...I'm beggining to get the feeling that maybe I need to reqroup with a new team and start all over again.....this drs. office does not rank in the top on answering and returning calls...as if I need this coupled with the issues with my PCP....well we"ll see...I be back

Shorty

You are so patient, I would jump in my car with a crazed look on my face and head straight in to deal with these "nice people" in person.....grrrrr

Mischiev...you make me laugh.....and I've been in the dumps all weekend...just the picture of it made me do a big one out loud....THANKS

Well I did get a call back about 1:OOPM..and as suspected my case had not been submitted....but I was assured that it would be by day's end and defintely by tomorrow morning....so I will start the web stalking of my Ins Co...my co-ordinator at the surgeons office say the turn-around is usually about 1 week...sooooooooooI'll keep you guys informed.....as I turn on the coffee maker..it's gonna be a long week...

Shorty

Good Luck, Shorty! I just read about your PCP, she sux! I think that you should stay on top of your team, too, by calling them again tomorrow to ask if your claim has been submitted yet. Just keep on top of it.

I'm pulling for you.

Kat