Question:
pcp referral?

ok, i was just diagnosed with diabetes last week. today i was put on metformin and actos and folic acid and lovastatin. my pcp dr does not want to give me the referral. he now wants me to wait another month and then have me go in to have my eyes checked then waite more time after that. DO I REALLY NEED THIS REFERRAL ? I m sick of being told to wait!!! its been 5 years now that all these Dr have said to waite, i friggin swear they do it on purpose!!! i have gone through every pcp Dr here where i live and it seems like none of them are bariatric friendly! if i change my pcp dr right now will that hurt this process or slow it down?    — candy L. (posted on February 14, 2008)

February 14, 2008
The truth is your diabetes will more than likly clear up after WLS. Also, because of this new co-morbidity that's one more reason why your ins has to deem the surgery medically necessary (along with your bmi 35 or higher). I am diabetic and it's a struggle. You have to do most of the things he's recommending. But all of this waiting....If you have a candidate for surgery--it's only going to help with your diabetes. I'm not a doctor but you know where I'm going with this. Is your surgeon's office requesting the letter from the PCP before they can submit your case for ins approval? I think you should also contact your surgeon's office and get their opinion. Good luck--You're in my prayers!
   — Ambitious

February 14, 2008
I had RNY surgery 9 weeks ago, and just two weeks after surgery the took me off three of My dibetic drugs, and two weeks later I started crashing at night with low blood sugar, so they took me off of Two more. Today I take nothing and my blood sugars are between 90 and 130 even after meals. I came off of blood pressure medication and colestroal medication last week, and I never have felt better. I work out at the Gym 1-1/2 hours every day for the first time in my 62 years. I had type II for 20 years. I would never beleive NY surgery would have cured me. Find a surgeon to do your WLS and ask him to assist you with your insurance company. I had to pay cash for my surgery, but it is the best money I have spent in years even if we can't take a vacation for a few years, I will be alive to take one when we can afford it.
   — William (Bill) wmil

February 14, 2008
Candy, I'm so sorry you're being put throgh the ringer with all of this! I'm a little confused, though, about some of your posting. First - does your insurance require the referral? If, so, you're unfortunately stuck with that, but maybe you could call them to see if they have any suggestions for you. Second, I'm unclear why no doctor in your area will give you a bariatric referral. Is it because of another medical condition? Or another reason that I've missed in your postings? Third, from what I remember some of us (including myself) had suggested an endocrinology referral. The endocrine system is simply the different glands in our body. Glands are organs that make hormones, which help to control bodily activities such as reproduction, metabolism (food burning and waste elimination), growth and development, and help to provide the proper amount of energy and nutrition your body needs to function. Endocrinologists are trained to diagnose and treat hormone problems by helping to restore the normal balance of hormones in your system. I'm unclear why everyone's telling you to wait, but I've been going round the system for almost a year so if I can help feel free to e-mail me at [email protected].
   — obeseforever

February 14, 2008
Most insurance companies want a referral. They figure the gp doctor knows your general health, and able to see whether you fit the pre conditions for this surgery. From you bio page, it appears you should qualify--BMI, comorbid conditons, general health, etc. Is there another doctors' paractice near you, or all of your doctors in the same practice in the same health center? You may have to drive some distance to another office as one option. Another option is to complain to your membership services office. This office would handle complaints about a doctor, your insurance coverage, billing questions, etc. They may be able to help you. AS long as WLS is covered under your insurance company, you should be able to explain to the merbership office your dilemma. 5 years is long time to be delayed, by repeated being told to wait some more time. YOU may not have been diagnosed with diabetes IF the surgery had been done already. In almost all cases of RNY surgery, diabetes either completely disappears, or can be moderated from a couple of pills weekly. I'd call the office completely. CAll in as if you were gong to make an appointment, and ask what the name of the department is to explain you situation. Good luck. DAVE
   — Dave Chambers

February 14, 2008
Yes, you really need this referral. All part of helping your insurance to see that you really need this wls whether they require it or not. Time to find a different PCP. Yes it will help speed up your chances of getting this wls. Try the next town over if you have in fact seen every single PCP in your town. Good luck, and God bless!
   — crystalsno

February 14, 2008
When I started this process 2 years ago my pcp wouldn't give me a referal. So I got on here and on my livejournal and asked if anyone else had gone through the same thing.. Lots of people had and was very glad that I wrote. The one main thing they kept pointing out was that "Im paying my dr, not my doctor paying me to be their patient." At first it was like hard for me to wrap my brain around it, but boy was I so glad when I called up another drs office and MOVED to them.. They were so right, now I have a doc who is there for me and I was able to have my surgery 6 months ago. Sometimes it takes people up to a year after they start the process, so even if you do not change your family doc there is going to be enough time to get your eyes checked and the wls surgeon will be running you through all kinds of blood work and psych eval.. You do not have to have a referal to have a consultation with a weight loss surgeon, to my knowledge, so if you have one in mind call them up and get info on where to start. Some places require you to sit through an informative meeting even before you have a consultation.. I hope this helps.. God bless you and best of luck to you Paula
   — japaad

February 17, 2008
You need to check with your insurance company and the doctor/clinic you want to see. If you have insurance that will cover wls, then you probably do need a referral. Even if your insurance won't cover wls, they might still pay for you to go to a clinic that treats morbid obesity so it might be worthwhile to check it out... usually there is a member/customer service number on the back of your insurance card or website with the same info. If you are going to be paying for this yourself, then it is up to the clinic/surgeon whether or not you need a referral. some places require a doctor (but not insurance) referral as it helps screen out some of the people who would not be appropriate wls candidates. I can't possibly see how changing your primary care doctor right now would "hurt the process" or slow things down as it doesn't sound like there is any process going on yet... frustrating, I'm sure!!! Your best bet would be to call the WLS clinic/surgeon you want to see (or any WLS clinic to start off with), and ask for names and/or recommendations of primary care doctors who have treated and/or referred patients for WLS in the past. Good luck to you.
   — mrsidknee