Seeing my PCP today to discuss lap-band...I'm nervous

[Maggie225 0]

(I posted this on another thread before I found this one)

I have an appointment today with my PCP and I'm going to ask about getting the lap band. I am sooo afraid he will tell me I'm not fat enough.....it seems weird to me to say that because I have been overweight my ENTIRE life, but my BMI is just over 35. I have always weighed over 200lbs but again I'm afraid he will tell me I'm not a good candidate for the surgery

I do have diabetes type II and PCOS and knee problems and I've also been on 4 different prescription meds for weight loss with no success.

I guess I'm just posting this to try to relieve some of my anxiety because I really, really want this surgery.

I would love to hear from anyone who has a BMI of 35 that has been banded and anyone else that wants to jump in here too:cool2:

[Jodi_620 37]

Sounds to me like you are a good candidate. Your stats are within the range acceptable for surgery candidates.

I was nervous about seeing my PCP too. I had already been to the seminar and had made up my mind that I wanted it done but his letter of approval was necessary and I was sure that he would refuse approval. But he was very supportive.

[Maggie225 0]

Thank you Jodi, your comment makes me feel much better. My appointment isn't until 4:30 today and as the time passes I seem to feel more relaxed. I really hope my Doc and Ins will both agree that this is a medically needed surgery:cool2:

[Band_Groupie 3]

Read: HERE

Your probably golden- Make sure you're well over the 35 and with most insurances you only need one comorbidity (but some you need more- diabetes counts, knees don't, but it will help your case. Let me know how it goes today!

[Jodi_620 37]

Maggie,

I was wondering how it went...

[Maggie225 0]

First of all I have to say to Band Groupie, I loved your blog. I have been doing the same thing you did, I have ate everything in sight for the last 2 weeks to get to the 35 BMI and I agree with you "its not fun when your trying to gain wait, I made myself sick a couple of times...LOL

Anyways, I had my appointment yesterday and my Dr is sending me for more tests for my Diabetes, my OB/GYN has been monitoring it for the last year but has not put me on any meds and my PCP was a little upset that nothing more was done for me (he's a great guy and very knowledgable) so I guess I am going to have a 3 hr glucose test and a kidney function test done. My Dr did tell me that the medicine that he plans to put me on will help me lose weight but when I asked him how much, he laughed and said probably not as much as I wanted. I did discuss the lap band with him and he did comment on how much I had researched it, he said he wanted to focus on the diabetes first (which is understandable) and then we can see where my weight goes from there. I am certainly not giving up and I figure every visit to him gives me another documented weight on file, right?:tt2:

[Band_Groupie 3]

Thanks Maggie. Glad it went well. DON'T let the PCP put you off from starting the process. My strongest advice to you is, even if you're 'just thinking about the LB' START THE DIET/EXERCISE WITH THE PCP NOW!!! You can even approach the PCP that way "I'm just considering this now, but I'd like to start the diet/exercise program now as it can't do anything but help me with the diabetes and if I decide on the LB then I'll be that much further ahead." How can your PCP say no to that...they put people on diet/exercise programs all the time? Trust me, if you do decide to get the LB, the 6 mo. program is the hardest part...waiting...especially if you're like me and you can't even really diet for that 6 mo. (I'm on the I'm not allowed to lose weight 6 mo. wait plan now). I went in recently for my surgeon's consult and in answer to my questions about being near the 35 BMI minimum the surgeons insurance lady there told me 'if you're below the 35 BMI then you really wouldn't need the surgery would you?' (translation-insurance won't approve you if you're below it at the time of approval)...so I am now 3 mo. into this and can't lose more than 4 more pounds...wonderful.

Oh, also...like you saw in my blog, not only do you need to have diabetes but you ALSO need to be on meds for it (for insurance to count it)...so get yourself on those meds soon...just keep in mind that you'll have a good chance of getting rid of the meds once you lose the weight!!!

Hang in there and keep me posted! Let me know if you don't have a surgeon's form on the information the PCP needs to collect at those monthly weigh-in's for the 6 mo., it needs to be more than your weight (I can give you the info.). I'd also suggest you start researching surgeon's in your area and sign up for a free seminar or two (I went to three hospitals), and get a copy of your insurance's bariatric policy...it's a simple phone call and usually they can tell you where to print it out online.

None of this is committing you...you can decide whatever/whenever you want, but you won't be wasting months with the PCP like I did (the main Dr. I see at my PCP office didn't think I was a candidate either). I wish I had him start the diet/exercise program the first month I went. Learn from my mistake. -BG

Edited to add:

just noticed you're in PA...let me know if you're near Pittsburgh like I am and I can give you my hospital info. (OH- ObesityHelp.com has a strong Philly group on the PA forum, but I'm not sure if most of them had the band or RNY...most of them used a Barix Clinic). There's a great group of people on here from PA (all over) also, so if you put your city/state in your title people here will give you info. on potential doctors.

Edited January 23, 2009 by Band_Groupie

[Maggie225 0]

Thank you Band Groupie:smile: I am in Genesee PA which is at the very top of the state next to the NY border, I did call my Insurance and I am covered if I have a BMI of 35 with 2 co-morbidities(sp?) I'm not sure if I would have to do the 6 month diet or not. Was that required from your ins or surgeon? I did look into LB doctors in my area and there are 2 at Arnot Ogden Medical in Horseheads NY which is a about 1 1/2 hr drive for me (and both doctors and the hospital are in my insurance network) I have UHC ins. and from what I've read on the forums most of the people with UHC have to submit 6 weights (over the 35 BMI) for the last 2 years, which scares me because I have dieted so much that I'm not sure if my BMI was 35 at any of those office visits.

Sometimes it feels like I take 1 step forward and 2 steps back:cursing:

Thank you for your wonderful suggestions and support, I really do appreciate it.

I will keep you all posted, because I am not giving up without a fight:rolleyes:

Edited January 24, 2009 by Maggie225

[Band_Groupie 3]

Yes, my insurance required the diet. For almost everyone that has to submit this, it's either 3 or 6 mo. (that's what they mean when they tell you '6 weights') and then here's the kickers for most ins.:

- They have to be CONSECUTIVE MONTHS (and within 2 years of your surgery date). I've seen people here denied for having too many days between them, but some ins. is more forgiving (ie. I was told by the ins. expert at my surgeons office that in our area, mine is the only one who will forgive missing a month if there's a good reason- but I haven't done this). I need to have 6 forms filled out to turn in from the PCP visits. Some accept things like Weight Watchers, but most ins. do not. Ask your ins. if the weigh ins need to be consecutive months.

- When you go it has to be for weight loss/exercise plan ONLY. I saw one person here denied for combining this with a sick visit to the Dr., she had to restart the 6 mo. after that...apparently the visits show up as a certain code to the ins. co. so they can see a sick visit vs. a weight loss visit.

- The visit must include the Dr. writing down specific information on your form/their notes which includes more than just a weigh in and calorie plan, it must also always include your EXERCISE plan and how you're doing, vitals, BMI, date, sig., etc. I've seen MANY here have to start over because they didn't include the exercise portion. Ask your ins. or the surgeon's insurance person for a form to use so you can gather the information (even if it's from past visits, the PCP can write it on the forms for you with the date and sign them).

- I can NOT go below the 35 BMI during my 6 mo. I've seen others here who could (usually after their surgeon's consult) and some that were given an amount to lose (is. 10%). If I go below the 35 at anytime during the 6 mo. I will not be approved. Ask.

- When they say 2 comorbidities they are talking only about the 5 biggies (even though most ins. leaves this very vague, like mine listed a few examples...dot, dot, dot. Again, learn what they really want). The 5 biggies are: hypertension, sleep apnea, high-cholesterol, diabetes and obesity related heart issues (some other major items sometimes also count like obesity related cancer). The other things like osteoarthritis, asthma, etc. are just 'helpers' to make your case, but the big 5 are what they're looking for. I haven't noticed anyone getting approved on PCOS as a main comorbid., so I believe that's also a 'helper' but you could ask if that counts as a biggie. So you probably need a second big one to qualify. Have your PCP order a sleep apnea test and ask for a blood test for cholesterol if you haven't lately (and ask if your blood pressure is high). A lot of people here had things they didn't even know about.

- Take some time to be careful about submitting anything before you know all your rules...I've seen people here get too impatient and do this and then you're stuck with either trying to appeal (which doesn't work if you got the rules wrong to begin with) or having to wait a certain long period before you can submit again. Know the game before you play it.

- Take the rules only from your insurance policy. I have BCBS and it's vastly different from many others policies even within the same state/area...it all depends on what was negotiated with your employer, don't take advice as gospel from others with the same ins. co. unless they work for your employer.

Good luck!