Question:
Why PCP would want me to lose weight!
Hello! I was just wondering why my PCP would want me to lose 22# in 3 months when considering the surgery? I am 5"4 weigh 225# my BMI is 38.6 at age 32.I suffer from acid reflux,arthitis in my knees,lower back problems,and high blood pressureand already had my gall bladder out and a hysterrectomy.She said I am not a candidate for the 2 diet pills.but if i lose 22# that would not qualify me. She asked that I do a 6 month 1500-1800 calorie diet,keep a food journal,see a physical therapist(which I started)keep a weight journal along with blood pressure one,see a nutritionist(which I made the appointment),get blood work.I just don't understand she is the one who reccomended the gastric bypass.I did do the Atkins diet for one year and lost 59 pounds but put it back on.Not allowed to do that because of BP.I have UPMC Enhanced HMO insurance and they do ask for medical management and pre-authorization to cover WLS. I do not have any medical document of weight lose. I am sorry this is so long just trying not to forget anything.If anyone could please help I would appreciate it very much.She did not reccomend me to a surgeon yet.Hoping I can get this done I have a family history of cancer,diabetes,heart disease.My mother was 51 years old weighing 386 pound when she passed away and I feel I am going in the same direction.THANK YOU — Robin C. (posted on September 1, 2005)
September 1, 2005
Hi Robin,
My primary insurance required a dr. supervised & documented history of
weight loss attempts in the past yr. prior to surgery before they would
approve the surgery. This may be why she is asking you to try to do this.
I'd ask her why. By the way, I didn't have the documentation either,
although I did try some of the diets recommended by my pcp. They didn't
document. My primary denied me but I was fortunate to also have a
secondary that approved it.
Good luck. Diana C. 234>230 -34lbs since 7/13/05
— Diana C.
September 1, 2005
Hi Robin
My PCP is requiring the same kind of things, but it's because my insurance
requires this before they will consider the surgery. Keep a positive
attitude and look at it as a step towards the surgery you need. Just a tip
- don't leave a doctor's office without understanding what's happening to
you - ask questions and insist on answers. This is hard sometimes, but
it's your body, your health and your life. Good luck - I know how you feel
as I'm on my first month of the 6 months supervised weight loss program my
insurance is insisting on too. Dorothy
— dinky
September 1, 2005
I was 252 when I started in the program with a lot of medical conditions..
I was told I had to lose 5% of my weight before surgery.. I lost 13 lbs
before surgery. It was acceptable... Most insurance companies require
that the patient to lose some weight before approving the surgery
— mzb2u
September 1, 2005
Have your doctor note in your medical records that he/she cannot recommend
diet pills for you due to your medical condition. Make sure that is in the
report! If you are unable to exercise for any medical reason, make sure
that is noted in the report. I was required to the do the 6-month diet and
I also could not take diet pills due to enzyme conditions and high BP. It
was ALL noted in my records. I also could not do certain exercises and
could only walk so much every day because of osteoarthritis in my back and
hip but it was all noted in my records. I lost in cycles on my 6 month
diet, just like I've done all my life. I would lose 5 pounds one month and
gain back 7 the next month. Lose 10 pounds and gain back 5. It was a cycle
for me. Just make sure everything is documented.
— Shayna T.
September 2, 2005
I always think that is odd, since if i could lose wieight without surgery,
why would i have the surgery? Most inurances need documentation that you
have tried to lose wieght. Your doctor will probably document your weight
loss efforts for a time, so that you can see if you need the surgery and
also have it documented for your insurance. If you succeed in losing
wweight, that is a bonus, and you might not need the surgery! If you do
not lose weight, then you can have the documentation for your insurance
company. Whatever happens, you win!
— Novashannon
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