Telling my PCP

[Natasha Estrada 36]

It just occured to me since I didn't need a pcp referral to my surgeon since I have PPO I haven't talking about WLS with my PCP yet. I have no reason right now to see her I guess I'll probably have my annual exam in the next few months. Do you think she'll be upset? Do I need any paperwork from her I wonder. The surgeon office didn't mention anything and my insurance requirements just says I need a "prescription" for surgery from an MD which I assume the surgeon is.

[terry1118 1,274]

My PCP referred me to the WLS information seminar. My surgeon sends all lab results and info from post op visits to my PCP also. I haven't been for my yearly physical because I've been seeing my surgeon every three months and getting frequent lab work done. They've been very thorough so it seems unnecessary at this point. I may schedule an appointment soon because I want to schedule a colonoscopy that I've been putting off for five years. Someone I know just lost a relative to colon cancer that was treatable if they had only caught it sooner. Wake up call! :-)

[Crosby 303]

This seems to be something that varies as it is dictated by the surgeon and insurance. I have to see mine monthly for weigh ins and just an overview of diet progress. You could simply call and find out but if it wasn't required I wouldn't worry. I just went through months of various tests and a surgery ( not wls) without seeing my pcp.

[Ginger Snaps 1,323]

I didn't talk to my PCP about it before surgery. I just decided I was interested in the surgery, went to a seminar and met with the surgeon. I did have to go see him the day after my second release from the hospital to follow up on the pneumonia and when I told him, he never said anything. I had talked to him every time I had been in about my weight and he had offered some suggestions but we never had a long discussion about it.

My insurance didn't require referrals, so I had no real need to ask my doctor beforehand.

[Sparklingbeauty53 202]

I needed all my records from my pcp along with a referral from him for consideration. I also had my endo's records and a letter of necessity from her. I had to show that weight was an issue for years and that I had all the comorbidities that they said I did and the records proved it. I think you should share with your pcp because after all is said and done that pcp will be checking your levels for the rest of your life after the surgeon releases you.

[AngryViking 217]

My insurance requires that my PCP give his sign-off to the surgeon. So even though I had a complete physical in April, and I told him all about it when I was there, I have to go again a week before the procedure for the "pre-surgical clearance".

[Natasha Estrada 36]

Oh I'll definitely tell her I just didn't know if I needed to make a special trip. I think she'll understand I had a colonoscopy earlier this year that found 4 precancerous polyps at the age of 34.

My situation is more like Gingersnaps. My insurance didn't need her to refer me so I just referred myself. But for years I've had *** so I guess I'm used to the gatekeeper system. Is Heathcare Management Organization a dirty word because it keeps on getting bleeped

Edited June 24, 2014 by Natasha Estrada

[Natasha Estrada 36]

This is what Blue Shield of California requires so far as documentation goes.

Initial Bariatric Surgical Requests:

 History and physical including prior weight loss attempts and responses, and comorbidities* (see below)

 Description of non-surgical weight-reduction program (e.g., physician supervised, organized weight-reduction program, or combination), initial weight, duration, and end weight

 Description of exercise program and duration or medical contraindication to an exercise program (if applicable)

 Monthly documentation of weight, dietary regimen, physical exercise, and behavior modification/behavior health interventions for six consecutive months occurring within the last 18 months prior to the request for bariatric surgery (e.g., medical records, and/or diet or weight-loss logs)

 Nutritional consultation

 Weight over the past six months

 Psychological consultation, that includes that patient has been cleared for surgery

 Medical doctor (MD) order for surgery that includes current height, weight, and body mass index (BMI), surgery requested and recommendation

 Comorbidities* (when BMI >/= 35.0 kg/m. and <40.0 kg/m.):

1. If diagnosed with coronary artery disease: Submit documentation from cardiologist that includes all previous and current treatments, as well as, member’s current status
2. If diagnosed with diabetes: Submit documentation from primary care provideror endocrinologist that includes all previous and current treatments, as well as,type of diabetes
3. If diagnosed with hypertension: Submit documentation from primary careprovider that includes all previous and current treatments, as well as, member’scurrent status
4. If diagnosed with obstructive sleep apnea: Submit official sleep study report interpreted by a sleep disorders specialist MD or Doctor of Osteopathic (DO)medicine and documentation

So I'm not sure if "Medical doctor (MD) order for surgery that includes current height, weight, and body mass index (BMI), surgery requested and recommendation" automatically = PCP

[alyssaajoan 36]

I have blue cross blue shield and I was required to get a certificate of medical clearance from my primary care doctor..

[Natasha Estrada 36]

Good to know. Though BlueCrossBlueShield is not the same as Blue Shield. Each state is differnent. My friend found this out the hard way because she has BCBS issued out of CT and assumed she could use any BlueCross of California doctor. Not so much. Had to send her this video.

I should clarify I'm not intending to keep anything from my pcp I just dont want to have to make an appointment just to discuss it

[amazon 579]

I have BCBS-MA and I think he had to sign something even though I have a PPO and didn't need a referral.

I did call and inform him so he wouldn't be surprised if faxed something from my surgeon. He was fine with it.

[itsmekarenlee 129]

We have United Healthcare PPO and don't need referrals either but the Bariatric Program required a surgical clearance letter from our PCP.

I like that our PCP is involved with this because the last bariatric surgery patient he had, (or knew of?) had complications and wasn't a good situation so he is very cautious. He did give us the clearance though. We are required to follow up with him two weeks after surgery as well. He and our surgeon will work together. That makes us feel better that he's in 'the know'.

[Racewalker48 41]

I also have United Healthcare PPO and needed a surgical clearance from my internist. He was the one who referred me to my bariatric surgeon, so he has been involved all along. I see him every 3 - 6 months because I have hypertension and he will be getting my lab results once I have them done.