Hi All,
I am new to the site and have been considering weight loss surgery for quite some time now. This was really a last resort for me. I have battled with my weight since I was 15 and tried everything I could think of. Atkins, Jenny Craig, Weigh****chers, Curves, Pills and many other diets. If I manage to lose alittle I always end up gaining it back plus some. I am turning 30 this year and just really tired of dealing with the same cycle. Have no energy to play with my kids and my body simply can't keep up anymore. I gets pains in my legs, back and arms. Had a physical done a few months back to check for thyroid issues. Turns out I had very low iron levels. Anyhow... I contacted my insurance company the other day to see if they covered weight loss surgery which they do. I am 5'1" weight is 218 BMI is 41.1

I have been on the phone every since trying to figure out what to do next. My insurance company is giving me the run around. I called and spoke to 3 people and each one told me something different. I asked them what the requirements were that they needed in order to approve a weight loss surgery. They basically told me that there wasn't a specific list of requirements listed which I find rather strange. They told me that I needed to have letter from Dr. stating that I was morbidly Obese and listing any health issues or risks I have. When I asked more they told me that I needed to have my Dr. call them and they could give more information. So I called several Bariatric offices and set 2 appointments for seminars. One lady was extremely nice and went above and beyond to explain everything to me as best as she could and gave me some good advice.

I scheduled an appointment to see my primary Dr. but honestly I am bit concerned because the last time I was there to see her, she tested my thyroids and gave me a physical. Everything came back ok except I had low iron. I explained to her I was having extreme fatigue, muscle pains, leg pains etc.... I told her all the diets I have tried and was wondering if maybe she would recommend some type of weight loss medication or something. She said she didn't like giving weight loss pills to patients. Then she recommended I try a low carb diet which I have done several times with no long term effects. Then she told me about a weight loss clinic so I went there. I met with them. Paid a crap load of money to get started. Spent money on all these vitamins and supplements they recommended for me. Then I couldn't afford to keep going and had to stop. It is hard for me as a stay-at-home Mom and only my husband working. Can't afford hundreds of dollars for these diets that are not working. And the ones that have worked I only ended up gaining the weight back. Most I have ever been able to lose on any diet I have tried was 30 pounds and that was on Atkins. Ended up reaching a plateau and then gained it all back and then extra. I have been dealing with my weight issues for years! Since I was a teenager. I am turning 30 this year and am just tired of the same old story. I need to be healthy and fit for my kids and my family. Now I am concerned that my Dr. will not write a recommendation letter for me because she doesn't seem to agree with pills or surgery. So I am hoping that she will do this for me. But not sure. Frustrated!

I feel ya.. I will be 30 in Feb, and what you described was me to a T.
I checked with my insurance and My policy didnt require me to have a letter from my PCP.
I have anthem BC/BS and the requirements were
1. Over 40 BMI
2. at least 6 month followed weight loss by a doctor ( that your sureon appraises)
3. approval from the therapist at the sugens office
4. Visits with the nutritionist

I have been doing this now for 2 month (but already had the followed weight loss, alos had a sleep study- i do have sleep apenia too- which will help with the insurance), attended all classes need from the surgeon to understand hat changes I have to make. I started watchig what I ate and cut out all pop, coffee and tea and have lost 11 lbs in a month. My surgeon was very impressed. My last meeting with him I signed the concent form and he told me I can pretty much pick a date, but the front desk staff said I had to wait for the approval from the insurance.
They just faxed everything into the insurnace company on 10/11/11.

I asked my PCP to write a letter over a month ago so I had something from im too,  and he has still yet to write it. Check with the insurance and see if you can read it for yourself on there website, email it to you  or if they can mail you your requirements.

Keep your head up!! Best wishes
Amanda

Sometimes a good surgeon can recommend a good PCP you can work with. I was unsure how my PCP would react because she had distinct ideas on how she wanted me to lose weight. So after I talked to the surgeon and realized I can use a PCP they've worked with if I sacrifice a little time to get to know him, I went in to my PCP and said, "ive done the research, I'm getting VSG and I need a PCP who can stand by me through it--can you be that PCP for me? I'd like you to, but if not I have another doctor who was recommended to me"

Sorta changes the playing field.

She's still my PCP and wrote a lovely recommendation letter.

I would change my PCP also.  Your PCP should be sensitive to your specific needs and concerns.  It makes such a difference to have a doc who will try to solve your medical issues no matter what it takes as long as it is safe.  I would make sure I was taking iron supplements because that will postpone your surgery.  I pray you will have success in finding a doc and getting approved!!!

Yes I contimplating using a PCP that the surgeon recommended. Just wasn't sure how long I would have to see them before they would recommend the surgery. I was trying to avoid prolonging this but if that's my only option then I will do it. I was trying to avoid having to switch PCP only for the mere fact that I had went to her in past about my weight issue and she did a physical on me and ran some thyroid tests. But I guess if I do end up switching they can always get my records from her anyway.

 Welcome! Sorry to hear your insurance experience has been so frustrating. Is there a way you can have them email/fax/mail you a copy of what requirements they DO have, so that you have something in print for them in case they try to pull shenanigans somewhere down the road? 

I had a similar situation with my PCP. I've been going to him for over 6 years now, so we've talked a LOT about weight loss. After meeting with the surgeon and telling him I was concerned my PCP wouldn't write a letter for me, he suggested I make an appointment with my PCP, and also said he would write a letter if my PCP wouldn't (so that's another possibility, or as others have mentioned, switching PCPs). My PCP is also not a fan of pills, and while he did say he'd rather see me make another attempt at diet and exercise (despite the track record), he did say he understood I was truly approaching surgery after exhausting so many other less invasive options. I took literature, I told him the research I had done, and we had a really great discussion. I had the same fears going in that you have with yours - but it's hard to argue with facts. As my PCP said, I don't have the co-morbidities YET....but with my family history, if I can't get the weight off, they'll be coming. 

What if you wrote down the weight loss plans you've tried, estimate the money you've spent, and present it to her like that? Any information you can give her to show her how this surgery IS medically necessary (for you and your family) should help...right? (I'm brainstorming here).