Question:
Can a PCP put the brakes on the whole thing because of his ignorance in obesity as a
On 6/8/00 I went to my PCP Dr. Robert Bourne, I submitted a letter testimonial to him regarding my family history, pre dispositions, and medical co-morbidities that I am currently suffering from. He basically told me about nutrition, and advised that this surgery was too dangerous and that people have problems in the future. I repeatedly tried to show him documentation that I brought with me about the surgical procedures, and informed him that I have indeed researched this surgery for quite some time now. I have read for many hours the patient experiences involved and the risks through the Obesityhelp.com website, so I am aware of the conditions that could arise. My doctor however insisted that I merely am depressed and gave me a perspiration for prosaic! I was so frustrated feeling like a prisoner in my body and know this doctor holds the key to a referral. It was hard to contain my control particularly when he had the nerve to ask me if I ever thought about hurting myself. He is a road block that is in my way, since I have HMO. I need to a referral to have my labs & go to Pacific Care Bariatric. Isn't it up to the experts in obesity, ie the bariatric specialist to make that determination or can a pcp's narrow opinion stop the whole process? Can a PCP put the brakes on the whole thing because of his ignorance in obesity as a disease, and further ignorance on the medical advances made to the gastric procedure? My entire family on my mothers side are morbidly obese, all live different lifestyles, my maternal grandmother and my sister are obese also. Help ! — [Anonymous] (posted on June 8, 2000)
June 8, 2000
Why don't you find a new PCP. It sounds like you are beating your head
against a brick wall with this one. You could check with different WLS
surgeons for names of some.
I think in most HMO's you can change your PCP at any time.
— Denise K.
June 8, 2000
Send him a letter noting what you have just stated. Be sure to include the
dates of your interactions with him. Call the physician you want to see
and request physician information literature. Include it and ask him to
review it. Let your PCP know that you insist that he consider a referral
for a surgical consultation and that you disagree with his assessment of
the risks. Advise him that you may consider changing physicians due to his
poorly informed management of your medical condition. If you want to be
very forceful, state that his position and care, while very conservative,
actually contributes to the continuation of your medical problem and, in
your opinion, borders on medical neglect. Ask him to reconsider his
position and to respond to you in writing at his earliest convenience. At
the bottem, note: "CC: File". Retain a copy of the letter for
your file and begin a anecdotal journal of your conversations and his
responses or failure to respond. If you haven't heard from him within 30
days, change physicians or schedule an appointment to discuss your letter
and his response. Consider appealing his decision to your HMO Patient
Services Rep. Hope this helps. Fondly,
— merri B.
June 8, 2000
My doctor was against WLS also. I just made an appointment
to see the surgeon and he took care of everything from
his end.
— kaydeeb16
June 9, 2000
I suggest you contact your insurance co. and let them know that your pcp
was asked for the referal and your pcp said NO! I had simular thing happen
to me and I contacted my insurance co. and was told that they CANNOT NOT
REFER YOU,THEY HAVE TO SUBMIT IT! That way, you will at least get your
denial for the appeal!
You can also put in a complaint against your pcp through your insurance
co.
Surgery friendly pcp's are rare, I have found this out!
Of course this is based on my insurance co. Pacificare HMO and they have
been sooooo much help!
— [Anonymous]
June 10, 2000
I think your best bet would be to change PCP's. I ran across something
similar. My PCP would not give me a referal because he said "he has
never had anyone without comorbidities ever be approved". According
to him, the arthritis in my right hip was not a comorbity. This is with a
BMI of well over 40. After learning more, I realized that it was my PCP's
medical group that would deny my surgery, not the insurance. I found the
surgeon I wanted to go to, saw that he was part of my insurance plan but
not in my PCP's medical group. So, what I did was ask the surgeon's office
who they would recommend for a PCP from my insurance company who would be
WLS friendly. Then I switched to that PCP! Much easier than trying to
convince an uncooperative PCP to change his mind. Are you local in San
Diego? If so, check out Dr. Callery in Poway. Great with the insurance
approval submittals (I never dealt with the insurance company directly and
was approved in three weeks) and the aftercare is great. His wesite is
www.thinnertimes.com.
— Gina E.
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