PCP gone MIA, HELP!

[w8loser 58]

I've posted this everywhere hoping to get immediate advice. So, here goes. I'm so frustrated right now that I feel like I am about to lose it!. I've completed ALL of my requirements for my insurance approval except today was supposed to be my final weigh-in at PCP. However, I got a call yesterday evening at 4:57 pm informing me that my appointment had been cancelled, my PCP had moved to Miami, FL & will not be returning. She's sending all of her patients to another doctor who won't be making appointments until February 3, 2014. Even then, she will schedule us as new patients & can't see me until March. Well, the problem with that is my weigh-ins must be consecutive & March appt will skip/forfeit January's weigh-in. To make matters worse, my regular PCP never sent my recommendation letter to my surgeon! So, to clarify...all I had left was my letter & last weigh-in in order to submit to insurance. What do I do now? I don't want to have to start all over again!!!! I'm in tears. Please, can someone give me advice as to what to do next?

Edited January 24, 2014 by w8loser

[lark60 430]

contact your insurance carrier and explain the situation to them. They can note the issue in your file and recommend the next step. They should let you establish with another provider (and will probably give you a list of names if you ask so you can see who can get you in the soonest) and allow an exception since this was to be your last weigh in. As for the letter, there should have been notes in your file with your current PCP and the new provider should be able to write the letter with those notes (or you could get lucky and find a new doc that is willing to go off your history and write the letter for you)

Good luck

[Bufflehead 6,358]

Your PCP is referring you to another doctor, but that doesn't mean you are obligated to use that new doctor. Speak to your former doctor's office staff and get copies of your entire chart. Go pick them up yourself. Meanwhile ask your surgeon for a referral to some local wls-friendly PCP's. Your surgeon's office may even be able to help out and call and make your appointment directly with a new PCP - this will help get you seen immediately, to have another doctor referring you and scheduling the appointment. Your surgeon's office should WANT to help you out here - the sooner you get your surgery, the sooner they get money coming in. If you are required to see an in-network PCP by your insurance, bring a list of approved doctors to your surgeon's insurance/patient coordinator so that they know who they can work with, if they need that info. Good luck!

[w8loser 58]

Thanks so much lark & bufflehead! I'm calling my Patient Coordinator at surgeon's office in a few hours to see if she can arrange a new PCP for me. Wish me luck...

[sweetjam69 20]

Your PCP is referring you to another doctor, but that doesn't mean you are obligated to use that new doctor. Speak to your former doctor's office staff and get copies of your entire chart. Go pick them up yourself. Meanwhile ask your surgeon for a referral to some local wls-friendly PCP's. Your surgeon's office may even be able to help out and call and make your appointment directly with a new PCP - this will help get you seen immediately, to have another doctor referring you and scheduling the appointment. Your surgeon's office should WANT to help you out here - the sooner you get your surgery, the sooner they get money coming in. If you are required to see an in-network PCP by your insurance, bring a list of approved doctors to your surgeon's insurance/patient coordinator so that they know who they can work with, if they need that info. Good luck!

I was going to say the same things!!!!

[allycatt98 35]

W8loser,

Does your insurance company have a Bariatric Program -- are you assigned to a Bariatric Nurse? If so, I agree with the other poster that you should contact notify your nurse. If you are not a part of a Bariatric Program, then I'm not sure that contacting your insurance company would be worthwhile at this point. But you might have a couple of options. Definitely try to establish with another PCP quickly.... but this is easier said than done right? Take a look at your insurance company's medical policy regarding the GS. Most will allow solid documentation from Weight Watchers or Jenny Craig in addition to clinician (MD/DO, ARPN, RD) documentation. For example, United Healthcare will accept Weight Watchers or Jenny Craig documentation in conjunction with documentation of at least two physician visits. So you could use Weight Watchers as an alternative this month if you are unable to see your physician.

Hope everything works out for you.

[w8loser 58]

Thanks everyone for the responses! I contacted another wls friendly doctor recommended by a friend who's had wls. I did have to wait a couple of hours but I got my letter & weigh-in. Patient Coordinator said she just received it & will submit it to insurance 1st thing Monday morning. Yes! Yes! Yes! Now I wait for approval.