Dr frustration

Cwood
on 2/25/17 10:20 pm

I need advice.

I spent over a year trying to get a referral  from my doctor. In mid December she finally said yes.

I called the network on friday...to see if they had it and they said no. So I called my drs office. Her seretary informed me that the dr had just finished it and had referred me to the medical program.she said the dr said I do not qualify for the surgical.

I need/want the surgical

Is it possible to be switched by the network....as I doubt my dr will. 

I weigh 220. I'm 5.5 tall

I have high blood pressure.

Stress incontinence 

Raynards syndrome.

Arthritis 

Hypothyroid. 

I do believe I qualify under the medical conditions 

Thank you for any advice

peachpie
on 2/26/17 2:52 am - Philadelphia, PA
RNY on 04/28/15

I get your BMI to be 36ish. Usually you need a BMI of 35 + 2 comorbidities. The only one you listed that counts is high blood pressure.  Your pcp must submit referral.

did you talk with your doc about your prior weight loss efforts? Maybe she thinks you haven't tried other means ? Most insurance will require a 6 month nutrition program anyway. Have you called your insurance to see what their requirement are?

you should be able to attend a WLS seminar without a referral... that would be good to educate yourself about surgery. 

5'6.5" High weight:337 Lowest weight:193/31 BMI: Goal: 195-205/31-32 BMI

Cwood
on 2/26/17 1:35 pm

I just rechecked the Bariactric Network website...for ontario Canada

With my Weight and BMi. I qualify if I have ...it states 1 of the following conditions.

Which high blood pressure is one of those.

I am not seeing where it states 2 of the medical conditions

NYC-Hot-Stuff
on 2/26/17 3:33 am

I believe that PeachPie is correct about your having only the one comorbidity that can be attributed to being overweight.  Unless you have more comorbidities, your BMI doesn't qualify you for surgery. 

Erin T.
on 2/26/17 7:12 am
VSG on 01/17/17

That is not always the truth. My insurance required a 35 BMI and only one co-morbidity. Type I diabetes was my only "issue" and I had a BMI of 36.2 at my first consult. I suggest the OP contact her insurance and figure out the specifics and then she'll know if it's worth the fight. 

VSG: 1/17/17

5'7" HW: 283 SW: 229 CW: 135-140 GW: 145

Pre-op: 53 M1: 22 M2: 12 M3: 12 M4: 8 M5: 10 M6: 11 M7: 5 M8: 6 M9-M13: 15-ish

LBL/BL w/ Fat Transfer 1/29/18

NYC-Hot-Stuff
on 2/26/17 10:01 am

Absolute agreement here -- the OP should get word directly from her med plan.  Not all plans are created equal, e.g., an HMO is not the same as health insurance.  Then, too, your Type 1 is a big one and may "weigh" more than some others. Maybe???

Erin, I knew someone whose high weight was about 325.  She had Type 1 and injected insulin four or five times daily.  After surgery and significant weight loss, she was down to one pill a day.  I've know others with Type 2 who ended up with no signs and normal A1C  Amazing stuff.  I hope you've done so wonderfully well, too.  I'm not diabetic, but I know enough to hate and despise the disease.

Cwood
on 2/26/17 1:39 pm

I Just rechecked the 

Ontario  Bariactric Network website. 

With my weight height and BMI it states that I need 1 medical condition.

I must not be seeing what your seeing. Can you direct me to where it says 2.

Thank you

NYC-Hot-Stuff
on 2/26/17 3:40 pm

You said nothing at the outset about Canada.  Most people in OH are in the U.S. and, as someone else already wrote, I thought you were, too.  I have no info about the system in Canada.  I did notice ahead that Pond Jumper suggested you get the paperwork in and take it from there.  You can't file an appeal if you haven't been rejected by the program that you hope to have cover your surgery.  It's still unclear from your posts whether you've gone that far.

Please keep in mind that we all wish to be helpful to others, but it can't be done when important details are left out.

Cwood
on 2/26/17 3:59 pm

Thank you.

I did. Not realize there was seperated groups for different countries...and that I had posted In the wrong one.

I have now posted in the ontario canada group.....just not sure how to delete this post

CerealKiller Kat71
on 2/26/17 4:29 pm
RNY on 12/31/13

It's perfectly okay to post here, and you don't need to delete your post.  There are plenty of Canadians that post both here and in the Ontario forums.  This isn't an "American" site -- there are people from all over the world who post here, although arguably, the majority are from the US and Canada.  

Now that people can see you are asking about the Canadian healthcare requirements, if they don't know the answer they just won't answer.  No big deal.  

 

"What you eat in private, you wear in public." --- Kat

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