Not an auspicious beginning...

Hello all, After months of deliberation and a lifetime of battling with my excessive weight, I finally took the first step and went to see a nutritionist/general practitioner who had been recommended to me by a couple of young women *****cently had bariatric surgery. They raved about his supportive attitude and compassion and urged me to seek a referral to a bariatric surgeon through him. He walked into the room and asked what he could do for me. I explained that I was there as a first step in the process of obtaining bariatric surgery. He looked as though I had just asked this question of an ophthalmologist! He asked why I had come to him for this purpose. I explained that I had been referred to him by 2 of my co-workers who had highly recommended him for this purpose. With a look of utter contempt on his face, he declared that he would not consider me to be a candidate for bariatric surgery, that I did not qualify for bariatric surgery. I protested "Of course I am! I am under 5 feet tall, weigh a bit over 200 lbs., have a tiny bone structure and frame, am being treated for sleep apnea, high blood pressure, angina, GERD, depression, plus a variety of aches and pains, all of which are directly related to my obesity and classify as significant co-morbidity factors. How can you say I don't qualify???" He said he could only qualify and refer people with over 100 lbs to lose. I advised him I could easily stand to lose 100 lbs and not be considered underweight for my height and frame. I asked him how he could base an evaluation of that sort without considering the very pertinent and relative factors such as height and frame? I asked why he did not compute his decisions based on the BMI, which is the universal standard for determining morbid obesity? He just looked at me with contempt and said he was not there to argue, that he would not recommend me for bariatric surgery, and asked if there were anything else that he could do for me. I said "apparently not" and left in tears. After a lifetime of not feeling that I was "enough," I had just been told that I was not FAT enough for a surgical procedure that could prolong and significantly improve the quality of my life!!! Talk about feeling like a COMPLETE failure!!! Then to add insult to injury, he charged my insurance company for an office visit and marked as his diagnosis "low basal metabolism' just to be sure he'd get paid! I love how he pulled THAT one out of his anatomy!!! Anyway, I am back to square one. I know who I want for my surgeon. I don't even think my health insurance plan requires a referral for a specialist. (It's Cigna PPO.) Any suggestions out there? Am I going about this in the wrong way? I sure don't want to go through another beating like that again! Gave up abuse a long time ago! Suzanne

I am so sorry you have expereniced this...that is so sad. Having cigna PPO you don't have to have a referral. You should be able to contact the surgeon you want and get in. Cigna does require a 6 month diet so be prepared for that. Your primary care doctor will be able to that for you. I file the insurance for our office so I am just passing along info that might be helpful. Good Luck and hopefully the rest of your journey will be a little smoother. Hang in there!!!!! Kim

Kim, Thank you so much for your reply. I just needed to lick my wounds a bit. Tomorrow I will schedule an appointment with the surgeon's office directly. Not too sure I will have the cooperation of my personal physician, but we'll just take it one day at a time. Thanks again, Suzanne

You will want the cooperation of your personal physician... it definately helps in the approval process to have a letter of reccomendation from them for you. In some cases the PCP is used as the person who handles the "supervised weight loss" that is required by cigna as well. Im sorry to hear you have had a hard time. If your PCP wont support you the surgeon could possibly reccomend somebody who they know will. Not sure what area you are in but we could give you some great ones if needed I would call your insurance company and put in a complaint about that physician. They do take complaints seriously and will put it on file with his Provider Rep... things like that are looked at when his contract is up and it is time for renewal. There may be others out there who had a similar experience as you so its important that the insurance company knows!

Thanks for the suggestions, Jennifer. I did in fact call the surgeon today to make an appointment, but they were closed to attend his wife's funeral! How awful for him! But I did leave a message asking for a callback and we will take it from there. By the way, I live near Wilmington. Thanks again. I will keep y'all posted on my progress. Suzanne

Wow - I'm sorry! That has got to be a blow. You finally reach the point where you decide this is the option you need - - and if you are like me, it wasn't a quick and easy path to that point - only to get slapped down by this jerk! Have you checked with the surgeon you want to see if they offer an informational seminar? If so, that might be a good start. I have Cigna EPO, which also doesn't require a referral for specialists. The one thing I have found with my policy is that they don't cover weight loss treatment, but they cover the surgery if approved. So when my doctor submitted a visit coded "weight loss", it was turned down. After that, we just made sure we discussed other things as well. I have gone to a seminar and had an initial consultation with the surgeon. I go tomorrow for all sorts of tests and will be seeing specialists, including a nutritionist and psychiatrist. The surgeon's office gave me some names of people their office deals with, and they will be making the appointments with the cardiologist/pulmonologist/etc. I'm sure others on here that have gone thru it can offer advice as well - - - as I'm just getting started in this process myself. But it seems that the surgeon might be a good place to start! GOOD LUCK!!!!!!!!

Sounds like your friends may have mislead you by reccomending that Dr.(???) Dont know what area you live in but there are several excellent programs at Duke in Durham,NC and Wesley Long hospital ib Greensboro. My wife rescently , last Feb and has done well losing over 110 lbs. It certainly helped with her arthritis in her knees. Good luck in your search as I am getting ready to embark on the same journey

I see that you live near Wilmington and from your last posting, I see you are going to have Dr Harris...he is a very very good surgeon. My PCP said that if he or any member of his family ever had to have any sort of laparoscopic surgery, Harris would be the one...says that Harris is known 'in the business' as the best lap man on the East Coast! I had 6 tiny tiny incisions and now, 14 months later, you can only see 2 of them and they are just tiny little red lines. I hope this helps! Pam 5'2" 9-13-05 282/145/145-AT GOAL!

Thanks so much for your words of encouragement, Pam. I had heard the same assessments about Dr Harris' skills when I was researching surgeons. His resume certainly backs that up as well. I am waiting for a callback from his office this week to set up an initial appointment, as Dr. Harris' wife died quite recently and they were all at the funeral when I called the office. If I don't hear by Monday I will call again. I am going to check out your webpage as I would like to know more about your history of your weightloss and maintenance. Thanks again, Suzanne

Hi Suzanne, Sorry to hear about your problem. Believe me I know what a jerk some drs can be. I started this process in Aug and I have been denied twice already. My surgeons office is doing an appeal for me since the appeal I sent did me no good. Im only 5' and 227lbs and they still denied me saying I didnt have enough documented diet history even tho they had plenty. My pcp told me he hates working with insurance co. because they could care less about us. They will probably keep me from getting this surgery that I need so badly just so they wont have to pay a penny for it. If I get denied for the third time Im thinking of getting a lawyer to help me fight them this time. Does anyone on OH know of a good lawyer ? Please let me know if anyone can help me Id really appriciate it. Well, Suzanne good luck to you and I hope everything turns out for the best for you. Take Care Dee