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Welcome Lesley,I second everything Pam said about Barix.I was one who had issues with them when it came to paperwork,people who dropped the ball,never returning calls losing lab work etc.But in the end it all worked out.I realized we really must be our own advacates with all of the redtape & hoops we are required to endure.I chose BArix because of Dr.P.I met her at her old practice a few years ago & as soon as I heard her explain things I knew she was who I wanted & trusted with my life.Best of luck on this incredible journey

Thanks again for your welcomes!  Right now I am thinking that I will go with the RNY and I'd like to have Dr. Pupkova do it, but I'm not done researching yet.  I will see my endocrinologist next week, and my PCP the following week.  Both have encouraged me to consider surgery, but I want to get their official blessing, and their opinions on surgeons, etc.  I figure I will also ask my PCP for a referral for a sleep study, as I am pretty sure I have apnea, and I assume I would need to get the test done anyway before surgery.  I have an appointment for a consultation with Dr. Pupkova later in the month, after I see my PCP. I had hesitated to take this step and to pursue surgery for so long, but now that I've begun seriously looking into it, I feel a sense of peace about it. I have gained a lot of weight from insulin resistance and I am not verging on type 2 diabetes (or I may actually have it -- it's not yet confirmed though) and I realize now that being a super morbidly obese diabetic is far riskier than surgery.  I have been working to make some positive changes in my life, and I feel that surgery will be a valuable tool to making some VERY positive changes for my health and my future. Sorry for rambling -- I'm quite full of feelings right now! :) Lesley

Lesley, You may want a letter of support from both the PCP AND the endocrinologist.  The PCP letter should probably contain the following:  Diets tried and failed, current weight, co morbid factors (diabetes, sleep apnea, joint pain, back pain, hypertension, high cholesterol ANYTHING), his support of the surgery and how it will benefit you.  Depending on insurance you will need a 5 year weight history as well (HINT:  If your BMI fell BELOW 35 at anytime in the past 5 years, you may be denied.  Make sure your weight for all 5 years puts you at a BMI of 35 or higher, so if you were dieting, don't put down what you got DOWN to, put down starting or gained back weight)    The endocrinologist can go into some of that as well, but the basic idea here is the more medical documented support you have for the surgery for medical reasons, the better off you will be. Pam