BCBS of Alabama and terrible PCP experience

[SummerShadow 27]

I have BC/BS of AL as well and am just starting this journey. My very first appt is in March with a surgeon, my very first step, but... my PCP sucks, and the last one sucks even worse (they're ratings online are spot-on). I'm a little outside of Montgomery and use Montgomery docs, but it's SO hard to find a PCP who isn't indifferent and with a crummy and often incompetent staff (I don't say that lightly either). I'm scared because I have to either stick with the doctor I have, who is one of those who speaks with you for a couple of minutes with his hand on the doorknob, office staff that won't answer the phone half the time (No menu or option to leave a message) and doesn't even let you know he's left the exam room for good until a nurse comes in to usher you out to pay.

I'm trying to be pro-active and get letters that I need before my surgeon appointment next month, but it's like pulling teeth. I called to see if I could get a letter from my previous doctor, because he's who I saw at the beginning of 3 years ago... and was transferred to a nurse who interrupted me mid-sentence and left me on hold for 10 minutes before coming back and telling me someone will have to call me back from "New patients" in order to make an appointment. Thing is, I told the nurse I just wanted to see if I could get the doctor to write a letter and/or suggest the appropriate medical records to show my weight and BMI dating back when I first saw him in Jan 2013. She didn't listen and told me my account is inactive because I haven't been his patient since Sept 2016, then sent me to records. I don't want to go back there, it's horrible, but my current doctor isn't much better. I also feel that NOW isn't the best time to find a NEW doctor as they'll have to do records requests etc.

I honestly don't know what to do. Already this stress and it's just the beginning of this journey. :/ Sorry my first post is nothing but a rant, but this is completely frustrating for me to already have a mess just trying to get a letter and records to show my weight and BMI. No one has called me back yet either and not sure when or if they will. Such is the nature of the beast with these two offices.

Thanks for reading. Again, sorry for the rant.

[marylu 12]

My doctor, who I have been seeing for over 12 yrs told that there was nothing he could refer me too. Now I was referred to the mayo Clinic-Jacksonville , where they recommended for me to have a sleep study done. When the Dr walked in, he told me that I really needed to do something about my weight. I almost started crying. Someone finally understood my struggle I had been dealing with. My own husband doesn't even understand. Why don't you take a different approach. Because of my weight, I had been stopped breathing 45 times in a hour & I feel like he understood & referred me to the bariatric clinic & he saved my life. Keep the faith & if you haven't had a sleep study done, have one done. All that weight on me was crushing my breathing & that's why I was referred to the bariatric clinic & my insurance covered the surgery.

[dg371 50]

You may just want to request all of your medical records from your current and former pcp. That's what I did. You may have to pay a fee but it's worth it. If you decide to change pcp from that point, ask your surgeon if there are any that they can recommend that are more understanding of your situation.

[dyemond11 43]

I had BCBS AL...they denied me the first time, and I had to do an additional 7 months of visits with my NUT and Dr. Not the surgeon.
You have to submit everything according to the policy or you will be denied as well.
If your BMI has not been consistently over 40 for the last 3 years, u will fall under a different category which means u have two options. As well as having one of the following high blood pressure, sleep apnea, diabetes that must be noted in your medical records.
Options;
1. You see a Dr. Not your surgeon consecutively for 7 months with 30 days in between each visit. 1st visit is consult, then ur 6 monthly visits. Your 1st visit and last visit must be 180 days from each other. Your doctor MUST note your weight loss goals, nutrition, exercise, etc...
2. You can see a Nutritionist that you see monthly that will document the same thing, weight, exercise, etc... or physically join weight watchers and go monthly, u can not do it online only. You will need 3 documented visits from the doctor as well in reference to your weight loss.
You have to show bcbs al that you have tried to loose weight. All your weight loss documentation has to be from the same DR.

I was initially denied because I had seen one doctor in Jan for a weight loss program, didn't get any documentation from Dr. In Feb, then had remaining documentation up until July from another Dr. Although I had proof that I was on a weight loss program my BMI went under 35, 34 to be exact they denied me as well for that which made it difficult to loose weight without falling under a 35 BMI.
The second time I submitted my information I did not submit my low BMI. In reference to your weight/ BMI history you will not need a letter, you will need actual Dr. Notes or visits, that has the date u went to the Dr. Your weight/BMI, U DON'T have to have every visit submitted, but as many as you can for that year. 1st time it took the insurance co. 30 days to deny, 2nd time a week to approve. You may also want to confirm with your Dr. Office if they offer online access for you to retrieve your medical records. Many offices are heading in that direction as my doctor office does & I'm from northern AL.


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[Crystalita83 2]

Hi, I am also a little outside of Montgomery!! Have you chosen your surgeon yet?