Question:
I have an appt.with my pcp tomorrow morning. What should I say to get my referral?

   — D. N. (posted on August 21, 2002)

August 21, 2002
hello, i've pasted in an article that i think i actually got from this website! lol...anyways it has some good info. you can also poke around obesityhelp.com and find some other good info for dealing with your pcp. good luck! kate Working with your Primary Care Physician HOW YOUR PRIMARY CARE PHYSICIAN CAN HELP YOU It is the job of your Primary Care Physician to obtain a referral to a bariatric surgeon. Some insurance companies do not require a referral. Be sure to KNOW whether they do or not. If you need a referral and do not get one, the insurance company will not pay. A letter of medical necessity from your PCP is an important part of the information you send to your insurance company when you are asking for preapproval for bariatric surgery. Any attempts at weight loss that the PCP has either suggested or ordered should be included. Important are any medications, dietitian consults or diets ordered. He should include amount of weight lost/weight regained for each attempt, if possible. Escalating weight gain for the past 5 years should be included, if possible. BC/BS demands those figures, though they can be approximate. All comorbidities should be included in this letter. It is up to you to be sure to inform your PCP of ANY comorbid conditions. Ask him to list the ones you describe to him in this letter. A copy of this letter should go to the bariatric surgeon you choose and to you for use in obtaining your preapproval. EDUCATE YOUR PRIMARY CARE PHYSICIAN Primary care physicians usually know little to nothing about Bariatric surgery. They may, therefore, say NO right up front. Or they will argue the point. Or else they firmly believe you can start a diet and you will be all set. An important step in getting insurance preapproval or even having a consult with a bariatric surgeon is to educate your PCP. Make an appointment with your PCP. Go to that appointment armed with data about obesity surgery. Don't take a million pages though. They won't take the time to read a lot of pages. While your information has to be comprehensive, it needs to be condensed just a few pages. Here is a sample letter to your PCP: Dear Doctor, I am asking for your assistance in obtaining weight-loss surgery. It is difficult and embarrassing for me to come to you asking for your help, yet I know and feel that my health has and continues to deteriorate because of my obesity. I have tried many weight-loss plans, including _______, _______, ________ etc. (list all diet plans you have tried). I now suffer from ______, _____, _______ etc. (list ALL your comorbid conditions) I have researched bariatric surgery in depth and I am well informed. I know there are risks associated with gastric bypass surgery, just as there are risks associated with any surgery. I realize that a lifestyle change and exercise are major components of bariatric surgery and I have already started making those changes. The experts at ObesityHelp, for instance, say bariatric surgery is necessary because it is the only proven method of achieving long term weight control for the morbidly obese. Bariatric surgery is not a cosmetic procedure. Surgical treatment of morbid obesity does not involve the removal of adipose tissue (fat) by suction or excision. What it accomplishes is reducing the size of the gastric reservoir, with or without some degree of associated malabsorption. This reduces caloric intake and ensures that the patient eats small amounts of food very slowly, while chewing each mouthful well. Success of surgical treatment begins with the patient setting realistic goals and progresses through the surgery and lifelong follow-up by the bariatric surgeon. The different, accepted surgeries have been worked out over the last thirty years, and are now standardized, clearly defined procedures, with well recognized and documented outcome results. Prevention of secondary complications of morbid obesity is an important goal of management. Therefore, the option of surgical treatment is a rational one. Morbid obesity is a disease, not a disorder of willpower. The physiologic, biochemical and genetic evidence is overwhelming that clinically morbid obesity is a complex disorder. Contributing causes are inheritance, environmental, cultural, socioeconomic and psychological. I have a couple of interesting and informative handouts from ObesityHelp.com. I have taken the time to print them out for you. I ask that you take a few minutes, at your leisure, and read them. Thank you for helping me. GETTING MEDICAL CLEARANCE FROM YOUR PCP AND OTHER DOCTORS Your PCP should write a letter of medical clearance to the bariatric surgeon you choose. If you have sleep apnea, you should obtain a statement from your pulmunologist who diagnosed it. You will need medical clearance from your pulmunologist also. If you have arthritis or pain of the weight-bearing joints, you should have your orthopedist write a statement of that diagnosis. If you have any heart problems, you should get clearance from your cardiologist. All of these statements of medical clearance and confirmation of comorbid conditions should be sent to you for use with your surgeon and your insurance company.
   — jkb

August 21, 2002
That letter is great that the last poster put in. Another bit of help to you esp. if your PCP knows little or nothing about the surgery is to go to ASBS.org and print the "Rationale for surgery". It gives references and is well written by MD's for MD's. My PCP appreciated the info even though he had no problem with giving me a referral. Good luck tommorow
   — Lynn L.