Question:
I have BCBS do I need a PCP for 3 YRS before I can have surgery and what is a PPO ?

I CALLED DR.OMALLY"S OFFICE AND I WAS TOLD THAT I SHOULD HAVE HAD 3YRS OF FAILED DIETS DOCUMENTED BY A PCP I ASKED COULD SHE TELL ME OF A PCP THAT COULD HELP ME START SOME TYPE OF TREATMENT SHE SAID NO. I AM SO DISAPPOINTED ANYWAY I HAVE BCBS CAN SOMEONE PLEASE TELL ME HOW TO GET STARTED I HAVE BACK, LEGS AND ANKLE PROBLEMS PAIN WITH HEARTBURN CONSTANTLY I CANNOT WALK FOR EXCERCISE BECAUSE I HAVE 2 HEEL SPURS AND IT'S PAINFUL TO WALK MY PODIATRY STATES ITS FROM BEING OVERWEIGHT I AM 5FT. 4IN. WEIGHING 290 LBS.ANY HELP WILL BE GLADLY APPRECIATED ALSO ANY INFORMATION THAT CAN BE GIVEN ON DR.FLICKINGER WOULD BE GLADLY APPRECIATED AS WELL THANKS IN ADVANCE.    — TANGIE B. (posted on August 1, 2000)

August 1, 2000
Pish Posh. I have BC/BS and was approved without a hitch. I can't even tell you how many failed attempts I've had because as far as I'm concerned every day was a failed attempt for me! Find another surgeon...one who isn't worried about his stats and is more concerned with his patients' health. Ask around for referrals in your area...you'll find someone that has a little more compassion! Best wishes....Sharon
   — Sharon F.

August 1, 2000
I have BCBS and was approved with no problem. I listed every attempted I had made and did not have any recent attempts with a doctor. I listed ever fad diet that I had tried, every program i.e. Nutrisysytems, Jenny Craig,Weight Watchers, etc, and every diet out of a magazine, and even acpuncture. They approved me with a week of submission of my packet. Go for it what have you got to lose, put weight itself. Tell the doctor you like for him to submitted the paperwork to BCBS and see what they say. I did have a few comorbities. Good Luck
   — ann A.

August 1, 2000
I have BCBS PPO (Federal) and they never asked for all that, but I had plenty of info anyway. Any old check stubs where you paid dues to Weight Watchers? An old contract where you joined a spa? Did any of your PCP's ever document that you were obese or overweight and they suggested a 1200 calories diet? All of these can be proof of tried and failed diets, as well as every book you ever purchased in hopes that that low carb, all protein, only grapefruit (get my drift) diet would help you...help this helps :-)
   — Alicia B.

August 3, 2000
I called and made a consultation appointment with Bariatric Treatment Center (BTC) before I even saw my PCP about surgery. They told me what my insurance required (I have BCBS PPO) and even sent me a list so I could collect the information and send it to them. They sent it into the insurance company and dealt with it from there. I had to get my medical records (I went back about 10 years) and highlighted my weight from each visit and also highlighted each attempt at weight loss. I had three doctor supervised attempts (Fastin, Phen-Fen and Xenical) but I never lasted for more than a few weeks on any of them. I didn't have any proof of programs such as Weight Watchers even though I had tried just about everything over the years. I listed all these unsupervised attempts. It will probably take you a while to get everything started for the surgery so find a PCP and have him prescribe Xenical or something right now. After a couple of months of this you'll have your documentation of weight loss attempt. Combine this with your past medical records showing increased weight over the years, any programs like Weight Watchers, any records showing your doctor gave you a diet to follow, etc., and you should be okay. The most important thing is starting it RIGHT NOW so you don't have to wait as long to submit everything to the insurance company. It also would help if your doctor wrote a letter to the insurance company stating all the weight related health problems you have and how much they would be helped by weight loss, making this surgery "medically necessary."
   — Kellie L.