HELP.. I need a GRoup Health Doctor!

bearpawga
on 7/26/07 5:47 am - seattle, w

Howdy Ladies and Gents, I"m pretty new to this bulliting board system.. I'm a group health member and am working very hard at trying to get into this Program for weight loss. I want the lap Band surgery but my Doctor keeps giving me the run around.  I asked him point blank what do you want me to do to fill out the paperwork to approve this surgery and he would not give me a direct answer. Does anyone know any Group Health Doctors who will work with me instead of against me? I understand there is a process to all of this but my PCP wont discuss the process.. or anything. Can anyone help me out here?

Thanks.

Suzanne_G
on 7/26/07 2:25 pm - Spokane Valley, WA
I saw Dr Songsteg (sp) in the Valley. She was great.. put in a referral for me right away. ( still depends if your plan covers, etc) But she was right on it.   Suzanne
Jeffrey Welch
on 7/26/07 3:38 pm, edited 7/26/07 3:39 pm - Seattle, WA
My primary care at GHC is Wende Wood, who has office hours at both the Downtown clinic and Capital Hill.  She has a special interest in diabetes. I approached her over a year ago, not with a "gimme the surgery" attitude, but a "I understand that GHC offers WLS and I'm seriously considering it.  I would like to work on my weight through conventional means over the next year.  Given my comorbidities (diabetes, arthritis, plantar fasciitis, hypertension), would you be willing to refer me we don't see substantial progress in the next year?" And work over the next year I did - and substantive progress I did not see.  She made the referral to the bariatric surgery program (lap band at the time was not an option, only RNY), and was very supportive. You need to have a realistic, staged approach if you want Group Health - a managed care program through and through - to approve you for the surgery (they only do about 10 each year).  You have to approach your provider with a genuine willingness to commit over the long-term, and an understanding of the risks and seriousness of taking this step. If you don't feel your primary care physician is listening to you - then by all means, see another, but they aren't in the habit of over-ruling one another (your entire record is there on computer, complete with visit comments).   My advice:  see another doc if you need to, but whatever you do - don't expect instant gratification.  Does your plan cover the surgery, or are you paying out of pocket for it?  Most GHC plans have specific exclusions for the surgery (my employer added a rider to our agency policy just so that I could have the surgery). -Jeff

 

 


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