Question:
I live in Santa Clara County, CA - Need supportive PCP
I have just changed insurance to Health Net, after getting tired of being denied by Kaiser. I need to find a PCP who is supportive of WLS, and who will know how to present my referral to increase the chances of approval by Health Net. Anywhere in Santa Clara county would be fine. I will appreciate any referrals!!! Thanks so much!!! Patience — Patience V. (posted on July 26, 2003)
July 26, 2003
Hi Patience, I can't help you with a PCP,but now that you're not with
Kaiser and have more choices, I hope you'll look into the DS. We have
support meetings the first Sat of every month (Aug 2 is next) at 10am at
the Regional Medical Center of San Jose, 225 N Jackson Ave, San Jose, in
the Peppertree room. http://duodenalswitch.com/ I hope to see you and
anyone else interested in learning about the wonderful DS!
— Chris T.
July 26, 2003
I am seeing Dr. Alison Van Egeren at Palo Alto Medical Foundation in Palo
Alto, on El Camino near University. She is a fairly young, skinny-minny
who is TOTALLY with-it regarding WLS in general and non-RNY surgeries as
well. She had another patient who had the lap band, and I am about to have
the DS, which she learned about by reading the references I gave her, and
was very enthused about my finally having a way to deal with my weight loss
issues. She was very respectful of my knowledge and preferences.<P>
However, I should warn you -- she had me write her LOMN and she printed it
on her letterhead, but probably had no clue how to help get the surgery
approved -- that, sadly, is going to be on you. YOU need to get copies of
your medical records, pore over them looking for the information the
insurance company requires for approval, circling the information,
referencing it in a letter, etc. NO doctor is going to have the time to
put together the package of evidence you need -- YOU will have to do it, if
you expect it to be done right and done well and in particular done in a
timely fashion. It took me at least 60 hours of work over six or more
weeks to put my letter together, from finding out the insurance company's
requirements, gathering medical records from several doctors in two states,
finding the required information, making charts with references backing up
the data of my weights and dates and calculated BMIs (I had to prove a BMI
over 40 for 5 years), finding out which of my various complaints was a
co-morbidity to reference, and establishing why the policy exclusion of the
DS was wrong in general and in particular with respect to my medical
condition. It was HARD work, and I'm a lawyer! And although I was
approved for the RNY after my intial request, my initial request -- which I
refused to back down from -- was for the DS. It took me 5 months of
appealing and losing before Aetna finally gave up and approved my DS
surgery.<P>
So, if you need a PCP who is philosophically in agreement with WLS, Dr. Van
Egeren is a wonderful choice. If you're looking for a PCP to write a LOMN
which will meet your insurance company's requirements, you are being
unrealistic in your expectations. You need to write it yourself, and have
a doctor like Van Egeren review it and sign it. It is WAAAYYY too much
work to expect your PCP to do. Diana
— [Deactivated Member]
July 26, 2003
Hi. I have a GREAT internist in Dr. Stacey Hein in Los Gatos, CA. She will
help write just about anything to get insurance coverage. She's great at
referring you to anything you need for WLS and she's a GREAT internist.
(Does EKG's and Labs right in her office). I help a lot of people in this
area get all their "ducks in a row" so to speak so their WLS will
be approved. I too dumped Kaiser when I wasn't "Fat or sick"
enough for them. (right). Please feel free to email me at
[email protected]. I'd be happy to help you too! --Sandie Guy RNY
8/13/01 Dr. Wetter, 282/137 now 2 years out!
— sandieguy
July 28, 2003
Hi Patience,
My doctor is Hernan Casanovas in San Jose, located at 2120 Forest Ave, #3,
across the street from O'Connor Hospital. He is very supportive and
caring. Good luck!
— Jean B.
July 28, 2003
I would definetly recommend Dr. Albert Wetter out of Burlingame. I know
you said, Santa Clara County, but this is not that far from where you are.
I am traveling all the way from Hollister.
— Greattobe B.
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