What conversation to have with PCP?

[Alisa_S 21]

I have an appointment with my PCP tomorrow to let her know that I want bariatric surgery & get a referral for my surgeon.

Are there any certain things I should bring up to my Dr? I have no doubt she'll be on board with the surgery. Anything in particular I should say, or ask for?

I've been told that I have sleep apnea by other Drs after having gall bladder surgery & colonoscopy, so I will ask for her to get a sleep study scheduled. I just assume I'll need one.

I spoke to my insurance, United Healthcare Choice Plus, and was given their list of requirements for approval 😕 & I will provide her with that list. I don't want to forget or miss anything that I should discuss. I appreciate any tips/suggestions. Like everyone else, I just want this to go as quickly & smoothly as possible.

[GreenTealael 25,430]

You may want to let the PCP know that you have been dieting unsuccessfully for x amount of time and what you have unsuccessfully tried to manage your weight so they can note it in your chart in case that is a requirement needed to receive the referral/insurance approval.

Good Luck!

[Alisa_S 21]

1 hour ago, GreenTealael said:

You may want to let the PCP know that you have been dieting unsuccessfully for x amount of time and what you have unsuccessfully tried to manage your weight so they can note it in your chart in case that is a requirement needed to receive the referral/insurance approval.

Good Luck!

Yes, it's requirement.

6 month supervised diet with documented failure of weight loss.

Documentation supporting the "reasonableness and necessity of a Gastric Restrictive Surgical Service being required, and significant clinical evidence that weight is affecting overall health and is a threat to life."

Psych eval

Nutritionist counseling

sigh

[SleeveToBypass2023 2,650]

Have you ever mentioned to your doctor, in the past, the things you did to try and lose weight? I have BCBS and they had the same requirement. But I had mentioned to my pcp that I did Keto, weight watchers, calorie restriction, and the mediterranean diet. When I mentioned this, she put it in the notes that went to the insurance company and they accepted it and that took 6 months off the process.

My pcp was very supportive and was happy for me to do the surgery. I gave her all the requirements from my insurance company (I needed to pass a ekg, her form stating what I've tried to lose weight, my comorbidities, etc...) he jumped right on that and got it done asap.

By the time I went to my 1st appt w/ my surgeon, she had already sent all of this to their office. So I was 3/4 of the way finished on day 1 of seeing my surgeon. All I had left to do was the psych eval, blood work the surgeon needed, and then waiting for it all to be submitted and approved by insurance. My first appt with the surgeon was Feb 28th, 2022. My psych eval was March 7th. Everything was submitted to my insurance on March 10th and I got my approval on March 14th 2022. The longest part of this was honestly actually getting to the surgery date because I couldn't have it until May 3rd due to the surgeon's schedule.

So honestly, the better prepared you are, the more you do behind the scenes, the faster the whole process will go.

[JennyBeez 289]

Good luck with your PCP today!

[Alisa_S 21]

29 minutes ago, JennyBeez said:

Good luck with your PCP today!

Thank you!

[Alisa_S 21]

Sleevetobypass2023 - I've mentioned it a little & I have months and months of weight charts on my Carb Manager account. I used to track all my meals there when I was doing Keto & Low carb. I got tired of tracking all the meals and started just tracking my weight on there a couple times a month. I think I'll print that out and take it to my PCP. Can't hurt I guess.

I did hCG diet back in 2010 (too long ago). In the 90's I did fenphen / phenfen - whatever it was, & dang near got a divorce because I got really mean. Tried just the phentermine about 6 years ago & it affected the same (my boss finally asked me if I wanted to work somewhere else-I quit taking it that day). Been fooling with keto or low carb off & on for the last 8 years. sigh. Through it all I just keep losing and gaining the same weight, over & over. Gosh I'm tired of it.

WEIGHT LOG.pdf

Edited July 19, 2024 by Alisa_S
Added weight log

[SleeveToBypass2023 2,650]

2 hours ago, Alisa_S said:

Sleevetobypass2023 - I've mentioned it a little & I have months and months of weight charts on my Carb Manager account. I used to track all my meals there when I was doing Keto & Low carb. I got tired of tracking all the meals and started just tracking my weight on there a couple times a month. I think I'll print that out and take it to my PCP. Can't hurt I guess.

I did hCG diet back in 2010 (too long ago). In the 90's I did fenphen / phenfen - whatever it was, & dang near got a divorce because I got really mean. Tried just the phentermine about 6 years ago & it affected the same (my boss finally asked me if I wanted to work somewhere else-I quit taking it that day). Been fooling with Keto or low carb off & on for the last 8 years. sigh. Through it all I just keep losing and gaining the same weight, over & over. Gosh I'm tired of it.

WEIGHT LOG.pdf

That's exactly the stuff you want to tell your pcp. That might be enough to cut that 6 months way down or even out completely.

[Alisa_S 21]

4 hours ago, SleeveToBypass2023 said:

That's exactly the stuff you want to tell your pcp. That might be enough to cut that 6 months way down or even out completely.

Sigh 😩I told her all that & gave her my weight chart from Dec 2022 to present and she still said "Mmmmm....I'm still going to need to see you monthly for 6 months."

Then added sleep study, EDG, and cardiac appt to the 6 month supervised diet with documented failure of weight loss.
Documentation supporting the "reasonableness and necessity of a Gastric Restrictive Surgical Service being required, and significant clinical evidence that weight is affecting overall health and is a threat to life."
Psych eval & Nutritionist counseling that I already have to do.

[SleeveToBypass2023 2,650]

1 hour ago, Alisa_S said:

Sigh 😩I told her all that & gave her my weight chart from Dec 2022 to present and she still said "Mmmmm....I'm still going to need to see you monthly for 6 months."

Then added sleep study, EDG, and cardiac appt to the 6 month supervised diet with documented failure of weight loss.
Documentation supporting the "reasonableness and necessity of a Gastric Restrictive Surgical Service being required, and significant clinical evidence that weight is affecting overall health and is a threat to life."
Psych eval & Nutritionist counseling that I already have to do.

Wait, so it's not your insurance saying what you had wasn't good enough, it was your doctor? I'm really surprised. My doctor looked at what I had and said "that works for me" and signed off that I had done 6+ months of failed weight loss attempts.

[ShoppGirl 5,003]

Maybe the reason she still needs to see you is if you were tracking but you weren’t going in to get your weight recorded. Usually They want to see your weight recorded by a dr every month for the six months. @SleeveToBypass2023 I think you just had an amazing doctor that took good notes to begin with then took the time to put it all together For you.

Edited July 20, 2024 by ShoppGirl

[Alisa_S 21]

Nope, she thought it was cool, but that's it.

And I just came to a SAD realization! I'll get all this testing done and have to shell out my full deductible for it all $4500, then IF I get scheduled for surgery in January (6 months) I'll have to pay it AGAIN because my deductible will start over. 😭😭😭

Oh my gawd!

[ShoppGirl 5,003]

15 minutes ago, Alisa_S said:

Nope, she thought it was cool, but that's it.

And I just came to a SAD realization! I'll get all this testing done and have to shell out my full deductible for it all $4500, then IF I get scheduled for surgery in January (6 months) I'll have to pay it AGAIN because my deductible will start over. 😭😭😭

Oh my gawd!

what if you schedule the tests for early January and just start the six months of visits now?! Because usually they wait until after the six months to submit to insurance and it can take like 30 days for an answer and then another month or two for the surgeons schedule. If you had your six months done and then knocked out them other tests like the first week of January then they could hopefully submit it all right after (unless you need follow up to any of that). If it is just the one visit though, That would be 6 months from now?? I mean ask the Dr if that works for her of course cause maybe I’m missing something but I hope they understand finances are important too.

Edited July 20, 2024 by ShoppGirl

[Alisa_S 21]

Oh thank you! I didn't think of that and you're really talking me off of a ledge right now! That's what I'll do, knock out the 6 month diet, then have the tests done in January and hopefully surgery soon after!

[ShoppGirl 5,003]

23 minutes ago, Alisa_S said:

Oh thank you! I didn't think of that and you're really talking me off of a ledge right now! That's what I'll do, knock out the 6 month diet, then have the tests done in January and hopefully surgery soon after!

Yea. I’m sure you would’ve thought about it once you calmed down a little. You just have a lot on your mind. This process can seem like a lot at times. You've got this though. Schedule if all now since some of them specialists take a while to get into so you have it as early as possible and double check with Dr that you won’t have to follow up for any Of it because that will mess up your timeline a little but hopefully it will all fall right into place. ❤️

Edited July 20, 2024 by ShoppGirl