PCP letter

My pcp wrote a letter for my insurance company (BCBS).  However, he is not willing to put in the sentence "12 consecutive supervised months of weight lose within the last 4 years"  I only see him once or twice a year, but we always talk about different attempts that I have made, diets, etc.  I have done all of the other things to prepare for this surgery.  He supports me getting this surgery, however he is unwilling to include that particular sentence in his letter.  I don't want that to be the end of my chances of getting a RNY.  Any advise??

I would suggest that you check with BCBS to see what they require for documentation of the 12 month consecutive supervised diet. The letter you're asking your PCP to write may not be what they require. I have BCBS IL, which requires a 6 month program and they require that I see a health care provider at least once per month for the entire 6 month period, and even though I've done that, I've still been denied due to reasons I cannot determine. I hope you have better luck with BCBS than I have!!

Well, it doesn't surprise me that your physician isn't willing to lie to an insurance company when you only saw him once or twice a year and not the 12 consecutive months that your insurance requires. It's not the end of your chances, but you will have to complete the diet. They are sticklers about it.

Wow! Have you dieted for at least 12 consecutive months?! If so, I don't see the problem but if you haven't it's got to be done. I have Medicare and they require a 6 month diet. I wanted to forego that but I realized that it wasn't the end of the world and besides it gave me another chance to observe my eating habits and patterns. It actually helped. The diet is now over and I am awaiting paperwork to be faxed but I'm still hanging tough to my new found lifestyle. I actually realized that if I'm going to have this surgery and make it a totally exceptional success I'd better start making permanent changes now and those 6 months were the best thing that ever happened to me. You have to realize what doesn't break you only makes you a stronger individual.

I also see that you said you only see your PCP once or twice a year. I wish that I could have said the same thing but I have some co-morbidities that just wouldn't let me stay away. As well as developing some new health problems that was of great concern and only dieting and close monitoring would eliminate them. I have seen my PCP so much this year alone that I know it could easily make up for about 2 or 3 years worth of visits and I know Medicare will be so happy to have me off of their insurance. But it has been so very well worth it and I know I have done the right thing. If you actually haven't did the diet do it for yourself, if it's a requirement there's no way around it. The best of luck to you in your journey!

 

Diane