Low(er) BMI: Need PCP Help and Advice (Mass)!

[soxaholic 0]

Hi All,

I'm 25 years old and have just begun the process to attempt to get banded. I live in Boston, and recently attended an information session held at Brigham and Women’s Hospital. I plan to (hopefully) have my surgery there. I have a BMI of about 36, so needless to say, I’ll likely have a tougher time with the insurance approval process. I have BCBS of MA, which fortunately, the Dr. who led my info session said has one of the easiest approval processes (no six month supervised diet or anything or the sort).

I do have to have at least one serious co-morbid in order to be considered. I definitely have high blood pressure – over the last year, and four different Dr. visits, my blood pressure has been high enough to be considered hypertension. However, at my last physical, my PCP told me that she wanted to put me on a diet to try to get the pressure down, and if that didn’t work, she would be forced to put me on meds (I insisted that I do it on my own with Weight Watchers - no luck). The insurance coordinator at the hospital told me that you must be medicated for your insurance company to consider it hypertension.

So, my question is, how do I handle this with my PCP? I know, nowadays, you pretty much need a referral from your PCP. I fear the referral process as it is, as I don’t get a very good vibe from her – I feel like she’ll be one to think it’s the easy way out, or I’m not overweight enough to go to such extremes. I’ve also only had her for about a year, so she doesn’t know me or my struggles very well. Do I take the honest approach and tell her what I’m considering having done…and if she seems receptive, ask to be placed on blood pressure meds? Or do I go in and ask to be put on the meds…and mention the weight loss surgery later? My fear is that she will say there is no way I am putting you on medication just to be approved by your insurance. I would agree if I didn’t have high blood pressure, but I do. How should I go about the process? Many people suggest switching to more supportive PCPs, but does it not seem weird walking in on your first physical and saying, “I need you to refer me for lap band?”

I would greatly appreciate any help, suggestions, or stories from people in similar situations. I should also mention that I was recently diagnosed with polycystic ovary syndrome, which causes the high blood pressure, makes you twice as likely to get diabetes, and is also a fertility disorder. There is no cure, but the best way to rid yourself of the disease is to get to a healthy weight – I would think this would at least help my referral and/or count as a sub co-morbid.

Thanks for reading the long post! :rolleyes2:

PS - Considering Dr. Ashley Vernon or David Lautz of B&W, so any opinion on either would be welcome!

[GratefulHeart 0]

Seems it would be easier to just be honest and up front with your current PCP - meds, lap band, the whole thing. She might surprise you.

[rodriguezequal 3]

I would tell your doctor that you have tried many times to diet and nothing is helping...Tell her that you would like to start trying the meds and that you are considering going to a seminar for lapband surgery and if you want you could even ask her opinion on it if you want to. In the end it is your desision to have it done and it is her duty as a doctor to allow you to seek the medical attention that is right for you...Give it a shot...she may surprise you :rolleyes2:

[MacMadame 81]

I think that's a good approach. If she is reluctant to put you on meds after you tried WW and failed, then you've got your answer... she won't be supportive and you need a new PCP. If she's on board with it, then you are okay.

If she's not onboard with it, ask your surgeon for a recommendation for a WLS friendly PCP.