HELP!!...How do I get approved with a new Dr?

[daraerin 0]

I am 31 and have a BMI of 52. My BMI has been over 45 since I was 23 and I have a couple minor health conditions - fibromyalgia and allergies/asthma. I used to go to the Dr. often for my fibro and Migraines. I have copies of all of my bloodwork, MRIs and xrays for the last 8 years showing that I have no other conditions (no hbp, diabetes, etc). I did a sleep study last year and the result was "mild positional sleep apnea" when I sleep on my back only. My previous Dr, when I asked about the surgery said "I'll think about it but lets try some other options" and gave me meds that had a side effect of weight loss (metformin even though blood sugar was fine and then phentermin) which I took for 5 months total to no avail. Actually my weight continued to increase. All my cholesterol panels are within the normals. Yet after all that the Dr said he saw no reason for me to have the surgery. I have good insurance - Blue Cross - and know they would approve it with a Dr recommendation so I decided to change Medical Groups. My very first appointment with my new Dr at the new medical group is next week. I will take every document I have but I don't know how to approach her about it. The new Dr. has a reputation of approving the surgery easy with her "longtime" patients but I don't know about new 1st time patients. What should I say?

P.S. Since 24 years old I have tried Weight Watchers for 5 months and again here and there, Jenny Craig for 8 months, a weight loss clinic for 3 months, herbalife, slim fast and various fad diets yet no significant weight loss. UGGGH

[stateofzen 46]

The first time I saw my PCP it was to talk about surgery. I just went in and told her I wanted to pursue weight loss surgery and asked if she'd help me through that process. Straight up and direct. We had a conversation, she said yes, and I'm banded.

I'd just be frank about WLS being your priority. If after hearing all of the things you've tried, your new doc suggests something else first, it's time to move on to the 3rd doc and try again :drool:

[malinda1229 1]

Does your BCBS plan REQUIRE a PCP referral...if not go direct to a lap band surgeon!! My BCBS plan did not require a referral!!

[daraerin 0]

Stateofzen - Thank you. I figured that was the way to go but wasn't sure how Drs respond to requests like that. I don't want to burn my bridges with the insurance company so I was worried if I went to too many Dr. they would automatically reject me.

Malinda1229 - I think I need a referral...actually I assumed I needed a referral since I have an HMO so I never even checked it out. I know they cover the procedure though. I will have to check on that. Thanks!

[racheyrach 0]

Does your BCBS plan REQUIRE a PCP referral...if not go direct to a LAP-BAND® surgeon!! My BCBS plan did not require a referral!!

mine also i havent seen my family doctor in a couple years so when going through the process the surgeon just wanted tests done to show risks and what not. so make a appt to go to an infomation seminar cuz that is the first step.

[honk 780]

You will need a referral for HMO. PPO do not require one. It sounds to me like your current doctor is anti WLS and nothing will change their minds. Some doctors are like that.

Call your insurance and find out whether they cover WLS surgeries and which ones. Each policy is different. They will also tell you whether they require a diet program. Some require 6 months. My policy did not require a 6 month program but my doctor did require me to loose 30 pounds which took 3 months. Many doctors require you to loose a % of your body weight (by doctor I mean surgeon).