I need some guidance -please

I live in chandler AZ and have been researching the lap band for alittle over a year and have been undecieded. Well now i am sooo ready and am not sure how to get started. I spoke to my insurance company and they state i need a medical nessicity letter from my PCP. I do have an appointment with her but seriuosly think she will not give me one. I have no serious problems but alot of joint pain, depression, etc. Do i need to write my insurance company a pre approval letter for me. I am also ready to get this now and do not want to wait. I have such nervousness that insurance won't approve and or the surgeon cause i have no serious problems yet. any guidance would really help thanks kelly

Hi Kelly, I would really talk to your PCP... if she is does not support Weight Loss Surgery I would suggest finding a new PCP to start. Like yourself do not have many co-morbities such as diabetes, high blood pressure, etc.. I have chronic low back pain and been obese for a long time and had plenty of documentation of attempted weight loss. Which I think helped me get approved. I see you live in Chandler, so maybe some of the Chandler folks can recommend a new PCP to get started with. I love mine, but she is over on 40th & Bell, that might be a bit of a hike for you! Good Luck! Nicole

HI Kelly: I had a complete blood test done and they came back great. I am not diabetic, no high cholestrol, no high blood pressure and no sleep apeena. But I have joint pain and in time my weight is going to cause me serious problems, like a heart attack. My primary doctor is all for the surgery.Also when I saw Dr.Juarez he also said I was an excellent candidate. I agree. If your primary doctor is not serious about weight control then find one that is. Your health is the most important thing that you have. Good luck.

kelly Go and talk to your doctor, Tell them why you want the surgery ! You might be surprised. If it dont work out there are lots of docs out there who do support the Surgery .. Dr Amy Lucas in Tempe is one .. I know of - also you can call your surgeon of choice and ask for a md referral . Hope this helps !! & good Luck !

Hi there Fellow Chandler Bud! I can give you a couple of suggestions..........I work for a Lap Band surgeon and we have folks call our office all the time looking for a weight loss surgery "friendly" primary care doc! So, whoever you have decided to go with, how about giving them a call. There are bunches of very support docs in our great state so there's no need to waste any of your "hunting" time on a "non-friendly" type! I drove a little bit for my great doc but Dr. Gary Wallace in Gilbert is very weight loss surgery supportive. In fact, his main nurse assistant had wls a few years ago! He's with Mesa Family Physicians. Just tell him that Joyce Plastow sent you. After, he goes, WHO? then just tell him, "never mind"......but she said you support WLS! *winks* As for pre-auth from any insurance company.......NOPE....you've got to follow their guidelines exactly before even submitting (something your surgeon's office will do for you). You don't have to have any major co-morbidity (ailment) to quality "if" you are at least 40 BMI or over. One or 2 just kind of cements your chances.....But, many good surgeon's can find a few things wrong with you that haven't been diagnosed....like "sleep apnea" for example. Many obese people suffer from that and don't even know that. So, when they're referred to a sleep study...they are quite often diagnosed with "sleep apnea" which is one of the considerations for a pre-auth from insurances. If I can help you with any specific questions, then just shoot me an e-mail. And....we'd love to have you join us at our local Chandler support group. They are held the 2nd and 4th Tuesdays from 6 to 7:30 at Chandler Regional HOspital. All are welcome...even those who are just in the "study stages"! Good luck with all, Joyce [email protected]

It has been my experience that if you have been more that a hundred pounds overweight for quite some time, that almost every primary care physician that I know believes in surgery, and is supportive. The tips above are all on the money. I have been more than 150 pounds overweight for more than 15 years. I do not have diabetes, high blood pressure, etc. I thought I was okay. But when tested for sleep apnea - bingo! A good primary care physician and a good experience biatric surgeon with a good support staff will help you qualify and help you through the insurance jungle.

Congratulations on your upcoming surgery Glenn!...As for pcp's being on board consistently for all who have been 100 or more overweight for a long time...Sadly, that's not the case. ... Many patients complain of the struggle they have had getting a letter of rec. from their pcp and many docs even refuse to do the required 6 month medically supervised diets that are required by most insurances. Some liberally hand out prescription diet pills which may have even more drastic side effects than a weight loss surgery! ..... Ooooooo, I have lots of bad stories I need to shake out of my head! LOL! The inconsistency of support for the obeses by the medical profession is one of my huge pet peeves in life! ..... I'll jump off the soap box now! It sounds like your health has been good and the WLS will most likely cure your sleep apnea! Good luck with all! Joyce

Joyce undoubtedly you are correct. I have been blessed with Doctors with eyes, ears, and common sense. However I found that a real good biatric surgeon will have a very good support staff, including folks who will help cut through insurance stuff and assist getting one covered and qualified. I chose Dr. Julie Ellner in San Diego since in part because traveling to San Diego is the same distance as to Phoenix and if I got to hang around after surgery I like hanging around the ocean, and in part because she is a nationally reknown biatric specialist. There is a great deal of money in biatric surgery, and as a result there is an incentive with the surgeons to get one qualified. Because there is a lot of money, and it is very profitable (if it were not Alvarado would not have built a specialty center devoted only to this type of surgery), it is incumbant to choose a real good surgeon to begin with. If you have a good credentialed doc with lots of experience in this type of surgery, then you won't be operated on unless you really need it. He or she will also have the support staff you need to get through the insurance jungle. If that does not do it, and there is still insurance problems, one can always call attorneys who specialize in insurance bad faith cases. Consult with one of these folk about helping you get covered. They may not know how to operate on you, but they will know how to operate on your carrier.

Hi Kelley - I just had the lapband done on Friday (yesterday!). You'll notice that people who do lapbands tend to be in the minority, but for some of us, it is a great choice. I was worried too that my PCP wouldn't refer me. However, she was quite good about it. I was worried about not getting insurance approval because I don't have any of the "major" comorbidities. However, my BMI is 40, and I have some minor comorbidities... Things I didn't really think about. And, I think another big factor was that I told them my family history. While I don't have diabeties and heart problems (yet), lots of people in my family do. Anyway... go for it. I picked the hospital I wanted to go to. (My insurance would only cover one of two different hospitals) and went to an informational seminar. They gave me the paperwork that I needed to give to my PCP.