Question:
PCP does not approve of this procedure therefore he will not help me with a Letter of
medical necessity. Should I ask my sleep doctor for help or a letter? He told me that if I would lose weight this would help with my sleep apnea and other related cormorbites? I see an attorney tomorrow, need all the suggestions I can get. Thanks in advance for all your help. — CINDY D. (posted on May 28, 2003)
May 28, 2003
You can try the sleep Dr. but I would also just get a new PCP. You don't
have to stay with a Dr. who is unsupportive and its no big deal to change
PCP's.
— Kris T.
May 28, 2003
You really do need a supportive PCP. Your PCP will be the one to monitor
you long term. He/she needs to be willing to work with you and your surgeon
to learn what to look for long term with you. If you like your PCP try to
educate him on wls, take information to him, write a letter explaining
exactly why you want wls. It has worked in the past for others. If not then
I suggest looking for a new PCP.
— TheresaC
May 28, 2003
I would find a new PCP. If you have a surgeon in mind, call his office to
see if they can recommended a WLS-friendly PCP...JR
— John Rushton
May 28, 2003
I told my sleep doctor first that I wanted to have WLS. He was very
supportive. I asked him if he would write a letter on my behalf and he was
more then happy to do so. I then went to my PCP and told her that I wanted
to have WLS. I also mentioned that my sleep specialist agreed to write a
letter. Right then my PCP became supportive and agreed to write a letter.
— S A.
May 28, 2003
Cindy, I would ask your PCP why he dont approve or support your decision,
and then I'd find another PCP, if this is what you want and you qualify for
it, find someone that will support you.
— Melissa Sanders
May 28, 2003
My PCP was left completely in the dark about my surgery. Didn't need him
for anything. My surgeon group has their own internist they send you to.
He clears you for surgery and orders your tests. The surgeon sent a letter
of medical necessity to the insurance. If my pcp even knows, it is only
because they sent him a copy of my discharge summary from the hospital.
— Delores S.
May 28, 2003
I agree with the others who suggested that you find another PCP who will
support you. A letter of medical necessity from your PCP is very important
to your insurance approval. You want that letter to be written by someone
who is behind you 100%.
— Bonnie
May 28, 2003
I went through this with my PCP. She didn't want me to have it because of
hypothyroid(thought it would make me a bad candidate). I let it go for a
month with her. During that month I made an appoinment with the surgeon,
and my lung doctor. Both said I would be a good candidate. I went back to
my pcp armed with information, explained to her what the other two doctors
had said, I also explained that I was an adult and that it was my decision
and that if she did not support me with it I would fire her and get a
different doctor that would. Two weeks later I had my letter of medical
necessity. Some doctors just don't understand this surgery or think that
you made the decision because you think it will be a quick fix. Make them
understand or find a different doctor that will. Good Luck Nancy-waiting
for surgery date.
— Nancy S.
May 29, 2003
I get so mad when I hear the problems that people have with their PCP's
regarding this! It is NOT their decision and you are not asking them to
approve or disapprove it. You are asking for a letter of medical
necessity. If he/she doesn't want to say in the letter that he/she thinks
you would benefit from it, then they can simply put in the letter your
health history and how it relates to your weight. They can list everything
from simple co-morbids (such as pain in the feet and legs and stress
incontinence) to major problems (such as diabetes and high blood pressure).
If your doctor will not do this, then you should find another doctor, who,
even if they don't necessarily jump with joy and clap their hands over it,
will at least support you in your decision to move forward. Get your
records transferred to the new doctor and he/she will have all the
necessary information to write you a letter showing medical necessity even
if they haven't been your PCP for a long time. Good luck to you!
— Lynette B.
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