Question:
Can a regular MD ruin my chances for insurance approval?
3-15-03..OK, so I went to a regular MD for severe headaches I am having. While I'm there I decide to bring up my desire for WLS, my weight history, diets I've tried, yada yada. She tells me that she doesn't think I'm a candidate for WLS. Then she "loosely" recommends another diet for me to try. (She never really gave me specifics or literature for it.) I wanted to say "have you tried it? If so, I guess it didn't work for you either! (She was a large woman herself). She said because I wasn't 300-400 pounds that she didn't think it was a good idea (my BMI is 38.3). Thankfully, I don't need a referral from her to go to a gastroenterologist (sp?). But she did send me to a sleep clinic (I go tonight!) so at least I can get officially diagnosed w/ sleep apnea. She also put me on Zocor because my cholesterol was 268 w/ the LDL being "off the chart." The problem (finally!) is that I'm sure she documented her opposition to WLS for me. Am I totally screwed now? Or if I see a gastroenterologist directly can I just bypass her opinion? I've only seen her this one time. Any advice would be greatly appreciated. — Andy B. (posted on March 15, 2003)
March 15, 2003
It likely depends on your insurance. Mine would require a referral from my
primariy care physician.
Also your BMI is just below the 40 that is considered to be morbidly obese
and at the point where insurance companies typically will pay for the
surgery. Maybe this is why your doctor denied you? Just a guess
Good luck on your journey!
— Jenny B.
March 15, 2003
Andy, you can always change your primary care doctor to one who is WLS
supportive, can't you? (I don't have insurance anymore, so I don't know if
this is possible). Different doctors have different thoughts on WLS. Lot's
of doctors that I've talked to over the years are opposed to surgery(any
kind) if there is any other way possible. The bottom line is this is your
body & you are the ultimate decision maker here. Good luck with any
& all decisions you make!
— LionGirl2k
March 15, 2003
I ran into a similar problem when my PCP went into her speech about how
weightloss was a matter of "will power". I got a new PCP the
next day, by a referral from a friend, not regarding WLS but more for
patient consideration. I did receive treatment for several co-morbidities
before even talking to my new doc about WLS, but I let her know right away
that I was not satisfied with my previous physicians standpoint on obesity
issues. When we did get to WLS (about 6 months after first seeing her), she
was totally supportive and wrote me a stellar letter. I just found out
this week I was approved, only three weeks after the info was sent to my
insurance company.
— J H.
March 15, 2003
Attend a support group meeting or call your perspective surgeoon and ask
for some recommended PCPs. Some docs just arent up to date on WLS, its time
to move on and find a better one.
— bob-haller
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