Question:
New Dr. says i am not obese enough for surgury

i started my journey a few yrs ago. I did everythign i was suposed to do. i got letters from a few drs. and went to the surgoen. the surgoen aproved me and sent everything including pics to my insurance company. well they denied me, so i wrote a 20 page appeal and was denied once again. well now we have a new insurance that will pay for this surgery, problem is my new dr. wants me to try all these drugs and stuff first..I have read about some of these drugs and i really don't care to take them due to the side effects. i called my surgoens office to see if he still had my file, so i could show this new dr. when i called that said they keep all files yet could nto find mine. Someone please help me.    — Denise H. (posted on April 6, 2003)

April 6, 2003
Is your new "doc" your everyday doc and he is a provider that works with your insurance or is this new doc actually a new surgeon who does WLS? Also curious as to who said you didn't weigh enough? Is that from a surgeon or from your PCP / everyday doc? Obviously if a surgeons office has done all the paperwork and was working with your insurance from before, unless something has changed (like you lost weight) things shouldn't be any different, other than any different or additional requirements your new insurance has.
   — Shelly S.

April 6, 2003
What is your BMI??? If it is over 40...then you qualify. Tell this doctor of yours that you do not wish to take these drugs because of the side effects. If that does not change the doctor's mind, get a new doctor. Remember people, your doctor is supposed to be working for YOU...and if you don't like the way you are being treated...move on. I can't believe that we as a society will stop going to a restaurant if we don't like the service, but we'll continue to go to a doctor who does not want to do what is best for us. Have a Sparkling Day!! ~CAE~
   — Mustang

April 6, 2003
MY PCP also told me he didn't think I was "big" enough for this surgery. I made sure I had done my research just in case this was the answer I got. I told him that I knew the guide lines (telling him what they were), the risk(naming a few), and all the options(what I've tried and how long I'd been fighting obesity), I even gave him stats on sucess rates of "diets", I then told him that I wanted the chance to make this choice for myself, and that I needed his referral to be able to even talk to the surgeon, and that I felt I was worth it. It worked! I got my referral and I'm 2 months post op, with a PCP who is thrilled about taking me off all the meds I was taking for co-morbids. Make another appointment with your PCP and go in armed and ready! If that doesn't work, call the surgeon's office and ask for a list of PCP's that are WLS friendly.
   — mildstorm

April 6, 2003
My first PCP didn't believe in this surgery and also didn't think I would qualify and/or my insurance would pay. In fact, he fired me as a patient. I wrote a panicked post on here asking for WLS friendly PCPs in my area and someone sent me the name of my current PCP who is an absolute doll. The time from my first meeting with my current to my surgery was about 8 weeks. Insurance approved immediately because my BMI was over 40. I wouldn't horse around with a nonsupportive PCP, I'd get another one or be more adamant with this one about not trying drugs. My current PCP did discuss trying a few other things before surgery but I had had it with everything and wasn't willing to do one more failed experiment. He was sympathetic. However, it turned out (after I saw my surgeon) that I really didn't need a PCP for anything but medical clearance so check with your surgeon as to why you need the PCP approval and if you can't do without it, find one who is more supportive or be insistent with the one you have.
   — susanje

April 6, 2003
My PCP said I did not qualify for surgery,I switched MD's, got referred, approved and as theysay, the rest is history!
   — ~~Stacie~~

April 6, 2003
Your BMI is over 40-dump the doc and get one that has a clue!
   — Kristen S.

April 7, 2003
Does your insurance require that you have a referral from your PCP to go to the surgeon? Mine didn't and neither did the surgeon. I made the appointment with the surgeon, his office got the insurance approval and I had surgery within a month. If you have to have a referral, get a new PCP.
   — Patty_Butler

April 7, 2003
When looking for a new PCP, I told them all that I was planning to have WLS and I didn't have time to waste if they didn't agree with the surgery. You have to upfront and frank. If they disagree with the surgery, check them off you list and move on to the next! Don't waste anytime on them!
   — aprilbaree