Anyone NOT been seen by PCP for WL

I haven't seen my PCP regarding my weight. Basically I have only tried on my own to lose weight. I got a call from my surgeon's office & my ins is requesting my PCP to fill out papers that I was treated for obesity by him. I have BC/BS of NJ & NEED to lose over 120 lbs. Is it possilbe that my PCP will sign this without having seen me for this? Amy

Didnt you have to get a referral for the surgeon from the PCP? Well i ran into a similar situation, where since i switched PCPs, my surgeon wanted me to go to my current PCP and get a referral for him. When i went to do this, they berated me and accused me of abusing the referral system and told me that the PCP would not just give me a referral for the surgeon or the surgery, unless i came in and explained it to the PCP and talked to her about my options. I was of course upset, because, by that point, i was 80% finished with the whole process and i didnt want to have to start over again, or be told by the PCP that she wouldnt clear me.. But i inevitably talked to a nicer woman at the office, and had her send the referral without the meeting with the PCP. It has not been a problem yet, but i still have a few weeks till my surgery, so I am worried that if i dont get that clearance letter, i wont be allowed to get the surgery. Its a bummer, but you might have to go to the PCP. Also, i know with Aetna, they require a documented doc assisted diet for the past 6 months.. That may be what the insurance is seeking. You should call the insurance company and have them be more specific. Good luck.

Ana, Luckily for me, our insurance lets us see any Dr. without a referral. I only go to the Dr. when I am truely sick & that's it! The Dr. I am seeing tomorrow I have only seen 1 time (large practice) but my father sees him all the time & has a great relationship with him. I am hoping that helps. Thanks, Amy

Hi Amy Carla, at Bertha/Abkins office, gave me a sample letter. The letter states that he/she has been your dr for # of years, and that you have struggled with your weight, and lists out your health issues, and thta you have discussed this procedure and the risks. My PCP signed it. He asked me to type a sample of what I thought it should say, and he put it on letterhead and signed it. BC BS approved my surgery. Good Luck. Ronnie

Ronnie, Carla did give me the sample letter, but I am just leary that the Dr will sign it being that he never did treat me for obesity.? Thanks, Amy

Amy, Didn't you get a sample letter in your package from the seminar? My packette from Dr. Bertha's office had a sample letter from the PCP.

Esther, I didn't go to a seminar. My husband had the surgery 2.5 yrs ago so I basically knew ALMOST everything. I just now am scheduled for the 3 hr class on 5/24. I have an appt tonight at 5:30 with the PCP so, hopefully he will sign it! Thanks, Amy

I see. The sample letter may be on their website. My PCP had the letter typed and sent in to Dr. Bertha's office for me. Maybe you can call Dr. Bertha's office and have them fax or email you the sample letter. I just finished all the testing they required prior to scheduling me. I am hoping for a July date when my kids are out of school. Good luck to you.

Amy~ I have the same insurance as you, but my surgery was approved almost a year ago, I know the insurance companies are making it harder for patients to get approved now though. At the time, I did have to see my PCP for the letter, I had been going to him for just 1 month at the time I decided I wanted the surgery, but he used all the past documentation from my former PCP to attest to all the struggles I had with my weight the past 8 years. I had tried about 4 diet pills, phen-fen which I loved, Jenny Craig, Nutrisystem, Weigh****chers... all that jazz. They approved me the first request, so think positive and if the doctor is a "fan" of the surgery he will probably make it happen. I will keep my fingers crossed for you! Michelle

Hi Amy, I have the same insurance that you have. I HATED going to the Dr, before surgery, so I only went to my PCP when I was on my death bed. He and I never spoke about my weight. However, I was diagnosed w/ high blood pressure and he had treated me for that. When I took him the paperwork for the surgeon he asked me about the ways that I had tried to loose weight and about the surgery and then he filled out the paperwork, it was just basic vitals and some general medical history questions that the insurance company wanted. I think it really depends on your PCP. Mine just happened to be really understanding and supported the surgery. I imagine if your PCP doesn't support the surgery, he/she would give your a hard time.