Question:
PCP not cooperative in prepping insurance case

I am considering Roux-en-Y, have picked a surgeon, and am working on completing everything that my insurance needs. I am down to the final item: "Letter of medical clearance for surgery from PCP and statement ruling out any endocrine disorder" Well, since I have a fatty liver and my Triglycerides are very high, my PCP thinks I am in danger of developing Pancreatitis (hope I spell this right). Bases on that she said that she won't clear me for surgery and has refered me to a Cardiologist. The thing I don't get is this: a) "Being in danger of developing Pancreatitis" is definetly not the same as "Having Pancreatitis", b) The bariatric surgery is part of the lifestyle change that is needed to do something about my high cholesterol, my high triglycerides, and my fatty liver. If that is so, why won't she clear me for surgery? Personally I think that she is not experienced with surgery, and Bariaritric surgery in particular, and doesn't want to expose herself to responsibilty for the approval (lazy, or timid, or stupid?) Should I get a new PCP? Get the Cardiologist instead to clear me? Get my surgeon to clear me? And if they put me on yet another diet (as if I haven't tried that in that pas) to lower my cholesterol, wouldn't I expose myself to the "risk" of losing short term weight which would exclude me from another qualifying criteria (min 100 pounds overweight).... I am sick of diets. They don't work for me! That's the whole reason why I want something permanent!    — mlangner001 (posted on January 27, 2006)

January 27, 2006
If I were you, I would be getting a new PCP. My PCP knew very little about bariatric surgery and she was all for me having it. She saw me every month for my supervised diet, always asked questions and never hesitated about signing a letter for my insurance company. (I wrote the letter for her and she signed it and put it on her own letter head) Actually part of my preop testing showed that I have a fatty lived and she called me to tell me that I really needed to go through with this because of that. Although she called me right after I had the surgery, she still wanted to make sure I wasn't going to back out. Maybe try going on the message boards for your area and find a PCP that someone else has used and had good luck with. Referrals are usually the best. Good luck.
   — *Malena* M.

January 27, 2006
Hi sweetie, I too, agree with "change your PCP". From experience I say that my original PCP (who I loved) would not agree to a referral for my WLS. It took for him to go to another practice and me getting a new PCP to get my approval right away. Some doctors do not agree with the very controversial procedures. I think its their personal feelings about the surgery that get in the way, and sometimes I dont feel that they are thinking of the patients best interest. Good Luck,
   — crazym68

January 28, 2006
While you are waiting for the surgery, you can ask your dr for cholestral lowering medicine. I take vytorin. All of my readings are in the good range now, except my triglicerides are a little high, but half as much as they were before taking the meds. It might reduce the chances for pancreatitis.
   — geneswife

January 28, 2006
I agree with you and the rest of the posters so far, that there's something wrong with your PCP. Check your insurance protocol for approval reqs and see if you can just get cleared through your surgeon. You may not have to have a referral even from your PCP. Otherwise, I'd change that PCP. You're right, there are both a lot of timid docs out there who don't understand things and don't want to accept responsibility. And then there are just dumb ones. Worst yet, there are those who are biased against this type of surgery, and obese people in general, and let that guide them. There are lots of us whose preop testing turns up some kind of obesity-related problems that we didn't even know we had (or in your case, could have, maybe, sometime? LOL) With me it was sleep apnea, gallstones, and a fatty liver. When you have a good doctor, they realize this kind of problem is yet another COMORBIDITY that means you're in danger and this is a further qualification meaning you NEED this surgery. WHen you have a bad one,t hey try to trip you up with it. Sometimes because these problems are just more what they're used to dealing with. So yes, I'd ditch the PCP. See if your policy would allow you to see a surgeon outright on your own, if you haven't yet. If you are seeing a surgeon, then clearance should be up to HIM, not her. Good luck!
   — christied

January 28, 2006
Hi, well I'm not sure where you live but here in Houston, Tx I was lucky to find Neweigh these guys did all the "foot work" all I had to do was keep my appointments. I would seek professionals if I were you dealing with Insurance co. is HELL! and IGNORANT PCPs too. Maybe you can find a bariatric surgery facilitator neer you?
   — SuzieD

January 28, 2006
I would get a new PCP, but also go to the specialist to get checked. As for the surgery, you still need to diet if you have it.
   — Novashannon

January 29, 2006
Of course you need to find another PCP. You are the consumer, and ultimately you have the final responsiility for your healthcare, not the PCP. I would sit down and speak with the PCP and tell her that you are planning on leaving her practice because you don't have confidence in her medical care. Usually when you phrase it this way, they have a tendency to rethink their position.
   — Harry King

January 31, 2006
Thanks for the answer so far everybody. Based on your responses, I will first have my appointment with the cardiologist to discuss my high truglycerides and see if he isn't willing to clear me for surgery. Next step would be a different PCP within the practice, and then a completely new practice.... It is just frustrating to get push-back in the least likely area: your own PCP, who should have no stake at all in this! thanks again for all the encouragement
   — mlangner001