What if my PCP says NO!?

[nallygirl 4]

Hi there! I've been researching WLS for a few months. I've attended a seminar for Lap Band, verified my insurance will cover it after the typical 6 month medically supervised diet and psych visit, I found a surgeon, discussed my decision with my family and have an appt with my PCP on Thursday morning to get the ball rolling.

As I was talking to a friend about it tonight she asked me the one question I never asked myself..."What if your doctor says no...what if they tell you all you need is diet and exercise?" Now I'm freaking out and starting to panic!! Has anyone had this happen?? What DO I do if she tells me no?!! I have fought this battle for 15 years, my BMI is 41 at 33 years old. I am ready for the rest of my life to begin and I can't do it on my own anymore. I'm sure I'm not supposed to say this but I NEED this surgery!!

What do I do at my appt?! How do I get this point across to my PCP?? What do I do if she tells me no?? Any advice is greatly appreciated!!

[CarolWA 0]

Hi nallygirl,

I'm pretty sure your PCP would have to have a good reason to say no. Some kind of health reason, not just that she doesn't think it's best.

When I talked to my PCP, I just told him that I was interested in the LapBand and he agreed. He did say he would not recommend any other type of WLS ( for health reasons), but he thought the LapBand would work well for me.

Good luck with your visit. keep us informed.

[nallygirl 4]

Thanks so much for your response! My PCP has been my doctor for almost 8 years now so she should be very familiar with my weight issues. I'm probably over thinking the whole thing and won't have an issue at the appt but once that thought popped into my head I had a momentary freak out! The appt is tomorrow morning so I'll be keeping my fingers crossed til then! :w00t:

[LRTAB 0]

My physician mentioned to me that studies of patients with lap band surgery has gotten lots of press recently in various medical journals - and they have all been positive. If yours isn't familar with it and the benefits, I'd be surprised.

Best of luck! I've run the gauntlet of pre-reqs myself, and am now waiting on the insurance company to pre-authorize.

[♥Amy♥ 5]

I agree. I wouldn't worry about it. I make worrying a career :w00t: and I had that thought, also but when I brought it up she was very much for me having WLS and has been very supportive post-op also. I'm sure your PCP will be the same way :wink: Good luck!

[tinksmom 0]

Do you need PCP approval? You might not. If she/he doesn't approve it, I'm sure the band surgeon will be able to refer you to a PCP who will...even if it is a temporary switch. You have to bear in mind that you are the consumer and you are basically hiring these doctors...even if you likethem you don't have to let them direct your course. You have a right to disagree and seek second opinions.

[nallygirl 4]

Thanks LRTAB and Amy!!

Tinksmom - Well as far as the PCP approval goes, according to my insurance (Cigna) this process needs to be initiated by my PCP if I want insurance to cover the costs. All insurance would really tell me is that yes they cover it if I have a BMI of 40+, that I will need to go through a 6 month medically supervised diet program and that my PCP will be able to give me more information once she initiates the process. Something about she needs to call a number and have me prequalified. I'm sure it will be fun dealing with insurance throughout this process! :wink: I will feel much better tomorrow after the appointment once I get this whole ball rolling!!

Thanks for the advice everyone!! :w00t:

[karmaandkismet 0]

I was absolutely terrified to talk to my pcp about it. She can be a bit intimidating at times and she's one of those tall, thin people who used to dance. I was so nervous that my HR was up. The nurse told me to take some deep breaths and to not be worried. When she walked in, she said I would be an excellent candidate and got my paperwork together to fill out. (Now trying to get the paperwork back from the front office staff was more of a challenge than talking to my doctor. They are not known to be prompt about things.) All that worry for nothing. I think a lot of pcp's are more up to date and educated on wls these days. More so than we give them credit for. If for some reason, your pcp says no, I was told at my lap band seminar to contact the bariatric group and they would hook me up with a pcp was open to the procedure.

[Alisomniac 0]

Hi there! I've been researching WLS for a few months. I've attended a seminar for LAP-BAND®, verified my insurance will cover it after the typical 6 month medically supervised diet and psych visit, I found a surgeon, discussed my decision with my family and have an appt with my PCP on Thursday morning to get the ball rolling.

As I was talking to a friend about it tonight she asked me the one question I never asked myself..."What if your doctor says no...what if they tell you all you need is diet and exercise?" Now I'm freaking out and starting to panic!! Has anyone had this happen?? What DO I do if she tells me no?!! I have fought this battle for 15 years, my BMI is 41 at 33 years old. I am ready for the rest of my life to begin and I can't do it on my own anymore. I'm sure I'm not supposed to say this but I NEED this surgery!!

What do I do at my appt?! How do I get this point across to my PCP?? What do I do if she tells me no?? Any advice is greatly appreciated!!

If your PCP says no, it will be to your face. Have a come-back ... you know "i need this because... ive done x,y &z, this isn't the 'easy way out because'... and hten work with your doc to meet his and your insurance requirements.

My PCP said OK to referral, even though I hadnt actually been in years, and only had verbal diet history (I have since gotten more since the medical group, not my pcp/insurance is giving me some problems)... Like I said, my med group wants more info so I'm sending in an appeal with my diet history, but ALSO going back to my PCP to also start on the requirements the medical group wants 'just in case'. I'm pretty confident I'll win the approval with insurance, but in case I don't I won't have to "weight" too much longer... my inital consultation was 3/29; revisiting 5/25 and from what i've heard so far, those two months will count for some of the 3-6 month diet requirement that the medical group wants.

[nallygirl 4]

Karma and Alisomniac - Thanks so much for the advice!

Looks like I worried for nothing...my PCP didn't even ask me any questions other than who is your surgeon so I can send them a referral!! YAY! She said she knows several patients who have Lap Band and love it and she thinks it would be a great idea!! One hurdle down now I am just waiting on the referral to come in the mail so I can make the appt with the surgeon. Then I also have to do the 6 month medically sup diet. My PCP is sending me for a sleep study too since she thinks I have sleep apnea...which in a way is a good thing...just one more thing to add to the list for insurance! Hopefully the rest of the process goes smoothly!! Thanks for all the advice and reassurance!! :laugh: