Question:
is there any point in filing for surgery w/bc if no

is there any point in going through h**l to get all this info together and get excited about surgery, only to have it denied? dr. rutledge requests all this info, but i don't have a pcp. mine died 2 yrs ago, no copies of my records could be found.i have no detailed diet history. i'm ready to just give up. i can't even meet the surgeons requirements about the paper work. my bmi is 48 and will be dead soon, probably. i need some help with this. any md out there i could go to for a letter of med necessity and them be my pcp?? i live in north alabama. please help!!!!    — elizabeth C. (posted on May 30, 2000)

May 30, 2000
Find a bariatric center in your area. They will help you in whatever you need. As far as diet history I made a list of what I tried and that satisfied my ins company. You need to get in touch with a doctor in your network. Who do you see when you are sick. Start with your office there. Make your own diet list and approximate dates
   — snicklefritz

May 30, 2000
I do not have BC, I have Prudential POS..but all I did was turn in a written list to my surgeon of all my weight loss attempts and how much I lost and how much I gained back. and that was plenty. I never provided records, nor did my PCP, I dont believe. good luck!!
   — Kim B.

May 30, 2000
Elizabeth, I have BCBS Federal and all I had to do was show my surgeon a list of what I did also. Did not have to provide records. Hope that helps :-)
   — Alicia B.

May 30, 2000
Hi Elizabeth, I can certainly understand your frustration with this huge mess in trying to get insurance to pay for surgery. First of all, if your PCP died then another doctor should have taken over his patient load. If not, then you should be able to go to the hospital that he was affliated with to request your medical records. By law, someone has to have those records SOMEWHERE. They cannot just disappear with the doctor. I would check the local hospital or hospitals to find out if they have any information as to who may have taken over those records or where they may be stored. Someone has to know something. Second, I would find a PCP in your network and begin working with him/her. This way, you will begin to have a history of trying to lose weight with another PCP and it will be documented. Most surgeons will require that you have a PCP anyway for follow up care. I know Dr. Rutledge does, by mere fact that most of his patients are from out of town and he can't follow up with them personally. So, I would begin searching for a PCP as soon as possible. I know that all I had to do for my insurance company was make a list of my "diet attempts" and their outcomes. And that satisfied them, they approved it rather quickly. You could also call your insurance company and find out what they will require from you in order for them to approve the surgery. Most times the surgeon requires way more information than the insurance company because they want to get the best chance of getting you approved. And having as much personal information and history from you the better, including the diet history. If you need any help I will be more than willing to give you a hand in any way that I can. Although, I live in Virginia, I will try to do what I can from here. Everyone goes through this and it's a tough road to travel, and yes going through the hell to get the surgery is well worth it. Please don't give up, it will all work out for the best in the end. Please feel free to email me if you would like any help. Good Luck...
   — Marni

May 30, 2000
I am sorry to hear that you are having this difficulty. I doubt, however, that you have to secure your medical records to document your weight loss attempts. Sit down with a pad of paper and a pencil and begin to list every diet that you can remember being on, whether they were through an organized group (Weight Watchers, etc), or physician supervised, or just on your own. Also include exercise programs that you went on to lose weight (like joining a gym). If you have trouble remembering, ask family members and friends. Try to remember when you were on the diet, how long, how much you lost and how long you kept it off. This is generally all that the insurance company needs - a thorough list that shows that diets have failed you. And don't worry about being perfect. If the insurance carrier needs more detail, it will ask for it. Good luck to you --
   — Kathleen B.

May 30, 2000
I was approved by a small group Blue Cross PPO plan in California. The clinic sent me a long list of Blue Cross paper work demands, which BC never in the end even asked for. Blue Cross approved me with just the letter of medical nessesity from my surgeon (within a week). By the way, I had no documented medically supervised weight loss. So give it a try, you never know. You just may get approval without having to jump through any hoops.
   — Jilda H.

May 30, 2000
I have a PPO (no PCP referral required), but my plan wanted to see my wl history. I typed up a list of all the diets I had been on and handed it to my surgeon with his required paperwork. He was impressed that I took the time to document everything and wrote a great letter to the insurance company. I was approved in less than two weeks. Just make sure you write everything down, i.e., Weight Watchers 3/99 to 6/99, beginning weight 275#, pounds lost - 23, Jenny Craig 9/99 to 2/2000, begining weight 285, pounds lost - 10, etc. I hope this helps.
   — heidiinPA