Need PCP referral....

[TraumaNurse 1]

So I thought the hardest part of this would be the insurance issue, guess I was wrong. Blue Cross Blue Shield of Massachusetts has said it will pay 100% for the surgery, of course providing I am able to get a referral from my PCP. This is were it makes me nervous. Last years physical I brought the subject up to him and he shot it down before I was able to finish my sentence! I am just so nervous he will again say no. What type of info did you share with your PCP to get them to approve a referral?? I really hope I'm overreacting, and after I give him my speech on the Lapband and how I am a great candidate he will have no other choice to give me a referral.

~Christina:Bunny

[leatha_g 4]

I believe I printed off whatever I could find supporting the lapband and I was able to recite some statistics of safety vs gastric bypass and presented them to my pcp. I didn't really ask him for his permission, as this is my life, but I did ask for his support in regaining my health by submitting a letter summarizing my past health history and comorbidities and how weight loss surgery might be an alternative to achieve that end.

[blossom 2]

My surgeon gave me a form letter to give to my PCP so that all she had to do was basically fill in the blanks. I wish I would have kept a copy. I did see a post somewhere on this forum where someone posted a link to something like that, but I can't find it now. Anyway, I guess the easier you make it for your PCP, the better your chances are of getting the letter. I took all my documentation with me to prove to the PCP that this is something I really need. I also took my "Don't you dare argue with me" attitude, LOL!!! Though, I don't know that it helped any. Good luck!

[leatha_g 4]

Mine wrote one sentence, something like. I'm referring Ms. So and So for weight loss surgery. lol. but I think it was more for my surgeon than the insurance company. I would think something a little more professional would be needed for them.

[Alexandra 55]

A referral from your PCP doesn't have to be for a specific type of surgery, I shouldn't think. It's not his/her place to determine whether you're a candidate or what sort of surgery you should have. All the PCP needs to do is give you a referral to a surgeon because you want to explore the possibility of bariatric surgery.

Your PCP may not understand the depth of your feeling, your physical and mental state, or even that there are other possibilities beyond gastric bypass. Give him the benefit of the doubt when you go back for this year's physical. Just say you've decided to pursue surgical treatment for your obesity and would like a referral to a surgeon for that purpose.

Believe me, it's no skin off his nose whether you go forward or not--the referral costs him nothing. Does he have a good reason for not thinking you should consider it? Does he truly understand that you're not seeking bypass surgery? Your doctor may have some biased position against all types of bariatric surgery, though, and if that's the case you just need to find another PCP.

Good luck!!

[claraluz 2]

You don't say whether you are in an HMO (which requires a referral for the surgery), but that's what it sounds like. I would hit him with a two-pronged approach. The first would be scientific: Go to the website for the American Society for Bariatric Surgeons and go to the section called "The rationale for surgery." It does deal mostly with bypass, but the rationale holds for ALL bariatric surgery. The NIH, The American Heart Association, The National Heart Lung Institue of Health (part of NIH) have all endorsed bariatric surgery for patients with a BMI of 40 and above. I think the Heart Association has too, but I don't remember for sure. Look up their position papers. I know I saw all of these position papers in an appendix of a book on weight-loss surgery (it was about bypass), but I don't remember the name. Then I would get him all of the information on LapBand (maybe Inamed could help you there). But I would also take Alexandra's approach and pour your heart out to him. Document all the diets you have been on, all the weight you've lost, all the weight you've regained. And tell him what being obese has done to you as a person - how you feel. You could do this in a letter if you want, but I would hand him the letter in person. It will be harder to ignore that way. You might also see if ObesityLaw.com has any advice. I think they deal mostly with insurance companies, but they may have some useful info. Good luck.

Nancy

nancy

[patty 0]

HI Christina,

I am in Mass too. I am scheduled for my 1st appointment next Tuesday at the OCC at New England Medical Center. I just called my PCP's office and told them I needed a referral to the OCC. They didnt ask any questions and I dont even have to go in to see him. I just have to remember to pick up the referral form. Good Luck!!!

Patty

[TraumaNurse 1]

Thank you for all your support and replys. I am in the process putting together all the info I have found along with my personal feelings about this surgery.. Keep your fingers crossed... Three more days till butterflies in my stomach and sweaty palms.....(read, appointment with PCP)

~Christina:Bunny

[TraumaNurse 1]

Just wanted to thank everyone again for the support and words of advice you gave me. I had my appointment this morning for a referral and was armed with lots of info. He of course gave me the maybe you should try another diet speech, but then went on to say it wouldn't hurt for me to see the surgeon and learn about my options.. So he gave me a referral, and wished me luck... He even remarked on how well prepared I was with all my research and lists of past medical/diet history... YAY! it's on to meet the surgeon... One hurdle jumped, let's hope his letter is convincing to the insurance company!! Oh and it's the one time I was happy the office scale was three pounds heavier!

~Christina:Bunny

[Iluvharleys 15]

Good Luck with the appointment!

[Alexandra 55]

I'm so glad to hear this went well for you! And you've now educated one more PCP who will be better equipped to talk with his next patient interested in banding. Good on you!

[blossom 2]

Yeah!!!! I hope all goes well with your insurance and you become a bandster very soon! Good luck!!!