PCP Letter of Support

[missvee 28]

It took me about a year and a half to make the final decision to venture on the WLS Journey. I was feeling defeated as everything I had been trying including diet change did not work for me for more than 2 months. I didn't have the energy or strength to do anything. I went to my primary and asked for a full work up and a sleep study. I came back with HBP, high cholesterol, pre diabetic, and severe obstructive sleep apnea.

My doctor gave me a diet plan which I followed for 3 months to the T!! Lost a total of 7 pounds, went back for a follow up and asked him who he recommended for WLS. His response was I didn't "need" it because my BMI at that time was only 36. Ummmmmmmmm yea but look at all my other conditions and I have tried for years to bring the weight down and as the years go by I'm all over the place.

My surgeon is requesting a letter of support from my PCP and I honestly don't think he's going to do it. I'm 3 months in and don't know how it would look to just change PCP's if came down to it for a letter. Would t that raise a flag to the insurance company? But my insurance doesn't require a PCP letter it's just the surgeons office.

I've been thinking about this and feeling a little down I scheduled with the primary for next week wish me well

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[Daisee68 2,493]

Hopefully your PCP will understand and make the recommendation. If you do not get the response you want and you happen to have any other doctors (such as endocrinologist which is who did mine), you might ask them. Maybe even an ob/gyn? There was someone else here recently who had to change PCPs to get the letter and I think their bariatric surgeon had a recommendation for them to go to. That would be beneficial long term too - to have a PCP that was aware of the changes a bariatric patient goes through and is supportive of same. For what it's worth, not sure my PCP was totally onboard (which is why I didn't ask her) but she is wonderfully supportive and proud of me now!

Good luck!!

[James Marusek 5,244]

I believe in my case my insurance required only a referral letter to open the door to the surgeon's office. It was the letter from the surgeons office that met the requirements for surgery. I had my surgery in a Center of Excellence. There are so many parts to the qualification process that a team is a better approach (psycological exam, insurance facilitator, medically supervised weight loss program, integrated support group meetings, extensive pre-op physicals and medical testing, training for the operation, post-op blood testing, post-op evaluations, dietitians). I had to undergo a 6 months of medically supervised weight loss and exercise program in order to qualify. Those requirements were a lot more detailed than anything my PCP could provide. I asked my PCP for such a letter and all I received was a blank look, because he had never done one of these letters before and didn't know where to start. After I met with the surgeons office, I was then linked to a doctor's office that specializes in performing this function and generating this type of letter. So after I completed the 6 month requirement (including attending bariatric surgery support group meetings), that doctor sent a letter to the surgeon's office whose insurance facilitator then included it with the packet she sent to the insurance company. And after biting my nails for a few months, it was approved.

I think in your case, you are trying to do all the steps yourself. The surgeon's office normally includes a letter that supports the fact that you have been attempting to lose weight. If the surgeon doesn't receive this letter, the package the surgeon submits to the insurance office will be incomplete, and your insurance company will likely decline the surgery. This letter will describe your effort to lose weight. What was your initial weight, what steps did you take to lose weight, did you attend support group meetings, what exercise did you do, did you track the food you eat (keep food journals), what co-morbidities do you have, did you lose weight during the medically supervised program.

The surgeon takes this letter and combines it with your medical testing results (such as the testing that determines that you had sleep apnea), and other documented co-morbidities and recommends that you receive surgery.

[esskay77 785]

I switched PCP's as well and it wasn't a problem. You can always switch back again later if you feel like you want to.

[missvee 28]

I believe in my case my insurance required only a referral letter to open the door to the surgeon's office. It was the letter from the surgeons office that met the requirements for surgery. I had my surgery in a Center of Excellence. There are so many parts to the qualification process that a team is a better approach (psycological exam, insurance facilitator, medically supervised weight loss program, integrated support group meetings, extensive pre-op physicals and medical testing, training for the operation, post-op blood testing, post-op evaluations, dietitians). I had to undergo a 6 months of medically supervised weight loss and exercise program in order to qualify. Those requirements were a lot more detailed than anything my PCP could provide. I asked my PCP for such a letter and all I received was a blank look, because he had never done one of these letters before and didn't know where to start. After I met with the surgeons office, I was then linked to a doctor's office that specializes in performing this function and generating this type of letter. So after I completed the 6 month requirement (including attending bariatric surgery support group meetings), that doctor sent a letter to the surgeon's office whose insurance facilitator then included it with the packet she sent to the insurance company. And after biting my nails for a few months, it was approved.

I think in your case, you are trying to do all the steps yourself. The surgeon's office normally includes a letter that supports the fact that you have been attempting to lose weight. If the surgeon doesn't receive this letter, the package the surgeon submits to the insurance office will be incomplete, and your insurance company will likely decline the surgery. This letter will describe your effort to lose weight. What was your initial weight, what steps did you take to lose weight, did you attend support group meetings, what exercise did you do, did you track the food you eat (keep food journals), what co-morbidities do you have, did you lose weight during the medically supervised program.

The surgeon takes this letter and combines it with your medical testing results (such as the testing that determines that you had sleep apnea), and other documented co-morbidities and recommends that you receive surgery.

I as well am at a center of excellence and you are correct in saying I did all of it on my own. Before the idea of WLS even crossed my mind I knew there was something wrong with me, hence the reason I went to my primary. I went to the primary not looking for a weight related solution but to find out why I was feeling the way I was.

Several months after trying what he said, I went to 5 different seminars until I chose my surgeon. My surgeon is the one requesting I go to my primary for a letter, it isn't a requirement for my insurance and I didn't need a referral to see a bariatric surgeon.

By my first appointment with my surgeon I had all my "testing" done. Not because I ventured out and did it on my own but bc I felt like something was wrong and didn't know I had the plethora of problems.

If it isn't required by insurance why make the push, if their office writes a letter themselves?

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[Djmohr 6,965]

I would ask your surgeons office for a recommendation on a PCP who supports Bariatric surgery. I would then switch PCPs. It is awful when you have a doctor who don't support it and you need a PCP who will follow you post op.

I swear, there are too many general doctors that are behind the times when it comes to WLS. They seriously don't know how to connect the dots with a post Bariatric patient. You need someone who is well versed and will order the right blood tests down the road.

My honest opinion is that you find a physician that is well versed in Bariatric surgery and supports it. It will ensure you have proper care both before and after surgery. Most important, after care!

[missvee 28]

I would ask your surgeons office for a recommendation on a PCP who supports Bariatric surgery. I would then switch PCPs. It is awful when you have a doctor who don't support it and you need a PCP who will follow you post op.

I swear, there are too many general doctors that are behind the times when it comes to WLS. They seriously don't know how to connect the dots with a post Bariatric patient. You need someone who is well versed and will order the right blood tests down the road.

My honest opinion is that you find a physician that is well versed in Bariatric surgery and supports it. It will ensure you have proper care both before and after surgery. Most important, after care!

Makes sense, thank you

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[ronr 3]

Hi Missvee,

I'm on a similar journey. Stay focused and do the best you can and be kind to yourself. I'm waiting for approval after being denied. I just can't let these insurance companies get under my skin but it is hard I admit. Stay connected to positive people.

Regards

Ron

[jnt1 37]

Some of you folks in the USA should think about coming to Australia for surgery. Its cheaper hete although i dont know exactly how much because its all covered on our health insurance. No questions from insurers if a doctor says you need it

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[dadsrebel 24]

I have been trying to get approved since last Aug. I finally got my surgery scheduled just to get a call telling me my surgeon was covered by my insurance but not the hospital he uses. He is a center for excellence surgeon so can only perform at this one hospital. I had to change insurance which cost me a month. Anyway I am now scheduled for apr 7. I am so ready to do this .

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[missvee 28]

I was able to speak with my surgeon and he said if the primary doesn't do it, then go ahead with my gyno I'm relieved

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[missvee 28]

I have been trying to get approved since last Aug. I finally got my surgery scheduled just to get a call telling me my surgeon was covered by my insurance but not the hospital he uses. He is a center for excellence surgeon so can only perform at this one hospital. I had to change insurance which cost me a month. Anyway I am now scheduled for apr 7. I am so ready to do this .

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Wow! I would've flipped! Sending positive vibes your way

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[babbit 24]

My WLS office gave me a letter that had everything they needed from the pcp, including 5 yrs of weight history, programs tried to lose wt, and a paragraph that she supported me having the surgery.

It was fill in the blank and sign. Easy peasy!

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