How your Primary Care Physician can help you

It is the job of your Primary Care Physician to obtain a referral to a bariatric surgeon. Some insurance companies do not require a referral. Be sure to KNOW whether they do or not. If you need a referral and do not get one, the insurance company will not pay.

A letter of medical necessity from your PCP is an important part of the information you send to your insurance company when you are asking for preapproval for bariatric surgery. Any attempts at weight loss that the PCP has either suggested or ordered should be included. Important are any medications, dietitian consults or diets ordered. He should include amount of weight lost/weight regained for each attempt, if possible. Escalating weight gain for the past 5 years should be included, if possible. Blue Cross/Blue Shield demands those figures, though they can be approximate. All comorbidities should be included in this letter. It is up to you to be sure to inform your PCP of ANY comorbid conditions. Ask him to list the ones you describe to him in this letter. A copy of this letter should go to the bariatric surgeon you choose and to you for use in obtaining your preapproval.

Educate your Primary Care Physician

Primary care physicians usually know little to nothing about bariatric surgery. They may, therefore, say NO right up front, or they might argue the point; or else they might firmly believe you can start a diet and you will be all set. An important step in getting insurance preapproval or even having a consult with a bariatric surgeon is to educate your PCP. Make an appointment with your PCP. Go to that appointment armed with data about obesity surgery. Don't take a million pages though. They won't take the time to read a lot of pages. While your information has to be comprehensive, it needs to be condensed just a few pages.

Here is a sample letter to your PCP.

Getting medical clearance from your PCP and other doctors

Your PCP should write a letter of medical clearance to the bariatric surgeon you choose. If you have sleep apnea, you should obtain a statement from your pulmunologist who diagnosed it. You will need medical clearance from your pulmunologist also.

If you have arthritis or pain of the weight-bearing joints, you should have your orthopedist write a statement of that diagnosis. If you have any heart problems, you should get clearance from your cardiologist.

All of these statements of medical clearance and confirmation of comorbid conditions should be sent to you for use with your surgeon and your insurance company.

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