My previous PCP may have **** me!!!!!
I recently changed PCP's so Dr. Scholten's office got my records from my previous PCP. When they got them, there was not a thing in there about weight loss. Not even the time she sent me to a dietician!!! I have every other co-morbidity the insurance company could want. But we may have a problem in the weight loss area!! I have records from doc's prior to that PCP. But that goes back to the 90's so it won't help even though I have been on diet pills, TOPS, etc. We are going to try to submit the info to the insurance co. any way. I am betting on a rejection.
If I do need to fight it, I can come up with weight loss attempts all the way back to when I was in high school. (actually, all I have known for as long as I can remember is trying to lose weight, I have always been over weight) I don't really want to come up with all of that considering I am......., well we won't mention my age. We will just say my oldest is 27 years old and leave it at that.
Lori,
What type of insurance do you have? I have BCBS Community Blue PPO and my PCP did not have to submit a SINGLE part of my chart. All he did was simply write a letter (that I can email to you) stating certain words and phrases and my surgery was covered! I too had to switch PCP but only because mine dies of a sudden heart attack. Don't lose hope yet and let me know if you want me to email you.
Jennifer
355/235/150
I have Humana Gold Choice. It is Medicare plus is the best way to describe it. It is a Medicare plan (Not Medicaid) that is available in some counties of Michigan at no additional fee that covers more than than Medicare does. I use this as my Medicare (they are contracted with Medicare) instead of my regular Medicare. I switched PCP's to kept better track of my husband's health. He is a health wreck, but not welling to take charge of it. So I am going to the same PCP as him again so the PCP and I can stay on him together. I have found in the past it worked and is working again. He is scheduled for RNY surgery on Dec 8. His diabetes and PB are under control again because I know what is going in again. By the way he has different insurance than I do. His RNY was a cake walk to get approved.
Well I don't know if this will be of any help to you, but here is the letter my PCP wrote.
To Whom it May Concern:
I have been Jennifer E's primary care physician since January 2000. She has suffered with obesity since the age of 14. She has been on several different diets for 12 consecuitive months at a time and she herself stating she has been on a diet her whole adult life. All her attempts have been without long term successful results. She is also under my care for asthma, stress incontinence, back and joint pain.
Her current weight is 355, height 66inches and BMI 57.36.
I have discussed bariatric surgical procedures and risk involved with her at length. She understands and will comply with post-surgical requirements. I recommend her to undergo bariatric surgical procedure and feel it is medically necessary for her morbid obesity.
If you need any further information regarding Jennifer E please contact my office.
Sincerely,
S. J. T., M.D.
Best of Luck to you!!!
Jennifer
good luck. i had that same problem, it was a total nightmare, i reported my previous PHCP to every insurance company and board i could and as far as i know he totally got away with withholding my records. i STILL get angry thinking about it. he refused to give us any notes or records on my dieting which had been done from the start with the intention of it being documented to meet the insurance company's requirements for WLS.
Keep hope, i got it done anyhow. You will too.
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