what to do?

Hello Everyone So, Friday I got a letter from Wellmark (see my profile for real specifics), basically they want me to take this letter to my dr. and have them fill out the information about my Obesity, and its treatment. Well here is my problem. I dont really have a family doctor. I havent been able to go to a regular doctor, only when I've been pregnant. So no one really has these records because they dont exist. I saw a doctor in like 2003. Once. I guess I just dont know what to do. I havent ever been technically diagnosed with Obesity,...anywhere. So what should I do. I know that if anyone knows how to get in and around loop wholes, or at least give me a tip on how high to jump to clear the hoops. I just feel like everytime I find a solution,....the door gets shut. Thank you for reading my post....

I would just jump in, get a new physician and get on the books with having obesity and go from there. I'd like to recommend Dr. Casey Clor at Mercy East clinic. He is one of the Mercy Center For Weight Reduction's Opti Fast physicians and I like him a lot. After WLS, I changed and made him my new dr. My husband liked him so well when he went through the Opti Fast program that he is his doctor now too. Mercy East Clinic is 515-643-2400. I am assuming you are in the Des Moines Area. I can't remember where you live. jean

Actually this is the clinic where I was seen in 2004. What I'm trying to do is get a letter so that I can get Insuarnce coverage. I applied to purchase health insurance individually with out an employer. So I filled out the application and WEllmark is the one to send me the letter so that I can get some insurance.. Thanks...any advice? Amanda

OK, I remember now..... Well, in THAT case, I would not get into too much detail with the doc about wanting WLS. Seriously, if he says in the letter to wellmark that you want WLS you might get denied insurance. Or they might make it an exclusion to coverage. I would just jump through this little hoop in order to get the policy, and tackle getting the medically necessary referal for surgery later. Are you reasonably healthy, all except being obese? I know Wellmark will cover WLS....but they can make it an exclusion on your policy. That is where a group policy is usually better, but I know you have no choice. Did you check to make sure that the specific plan you are looking at purchasing will pay for WLS? And even if it does, will it look at your situation as a prior issue (that's not what it's called, but I can't remember the correct phrase right now). I just want you to make damn sure the policy you are going to be spending a zillion dollars on will actually pay for this surgery. I would hate to see you get screwed. hang in there and do NOT give up. You have come too far. jean

Jean can you tell me more about this Dr. Does he let you get the labs you want drawn? I have problems with my PCP wanting to do labs. I want to stay healthy so like to get a lot of things checked. Does he understand the need to do this to remain healthy?April Does anyone have another Dr that they like that meet the above standards?

I also forgot to say in my last note that I also have Wellmark BC/BS and they approved me with no problem for WLS. And if I remember right, you don't even need to jump through a lot of the hoops if you have a certain BMI. So, perhaps they don't care about past doctor visits, just presently. So, get a doctor and have him write you a letter of medical necessity. Dr. Clor would do that as he works a lot with the treatment of obesity in his capacity as an Optifast dr. They recommend him at the weight reduction clinic at Mercy Capitol too. I don't think I even had to prove my comorbids because I met the BMI criteria and was more than 100 lbs overweight. Are you going through Mercy Capitol? jean

I didn't have a regular doctor, either. I needed a letter for insurance, too. I called a local internal med doc and explained to his nurse what I was looking for, and she set up the appointment. I was so scared to have to explain my story to the doctor, but he was great and said he would have no problem writing a letter on my behalf. Also, I had mentioned to my OB/GYN about the surgery (only because she had talked to me about the need to lose weight at the previous yearly visit), and she offered to help me out in any way. I decided to ask her to write a letter for me also. For UIHC's program, they have you make out a diet/weight history, too. So my diet history that i wrote out along with the 2 doctor letters were enough for my insurance company. It didn't seem to matter much that I had only seen the one doctor once and had only seen that OB/GYN a couple times. I think the letter from the OB/GYN helped the most because there was at least some documentation of a pattern of obesity from a prior yearly visit. I read your profile and saw that you have kids....have you had the same OB/GYN for a while? Maybe you could talk to them to give you a letter? Or even if you saw different doctors, maybe you could get all the records from the past few years and could find a doctor that will look them over and write a letter to at least establish a general history of obesity and you could talk with the doc about your personal weight loss attempts and they could put that in the letter as well. Hope this helps, molly