Question:
Question about PCP referral...

I have been overweight for years. I am however a bit concerned and need suggestions. I don't have any documented proof that I have been trying to lose weight over the years. My mom is my PCP's nurse and everything he has done for me has been on a professional courtecy. He has written a very nice letter stating all my co-morbidities and the different diets throughout the years. Have any other suggestions as what I can do to be more convincing? I am going in once a week now to get weighed. PCP said he would call insur. comp. if needed. Any thoughts/ideas would be great!!! : )    — Tracy T. (posted on October 24, 2001)

October 24, 2001
I happen to work in a PCP refferal office and know that the letter will help. You also need to see the surgeon that will be doing your surgery and he will know exactly what to say as my Surgeon wrote a really depressing letter to my insurance company. Gathering as much information about your self and past history is what you will need as well as a letter of Medical Necessity (which may already be the letter that your doc. has written)Do you have diabetes, high blood pressure heart condition etc.....The insurance company will want to know everything about you in order to see if this surgery is worthy of approving for you. Its a pain to go thru this but I can tell you it is worth every minute. Im 10 weeks out and down 51 lbs. Its really a great feeling. One more tip once you submit everything to the insurance company constantly call the utilization mangagement dept and bug the living day lights out of them of course do it in a nice way. GOOD LUCK...:)
   — Melissa S.

October 25, 2001
That letter seems like excellent documentation of medical issues and your diet history. Your next step is to arrange a consult with a surgeon...take your PCP's letter with you. If the surgeon thinks you are a candidate for wls, his office staff will start the insurance approval process. Good Luck.......
   — [Anonymous]