Help with Primary Care Physician in Houston

This is long but bear with me. In less than 3 weeks after applying, insurance is on the verge of approving my LAP-BAND® procedure but I have run into the problem I predicted with my primary care doctor. When I first approached him for his opinion, he told me he is no expert on bariatric surgeries but asked me to talk with a gastric bypass surgeon. He also expressed doubt I would qualify because he did not think I was overweight enough. I am 90 pounds overweight and have been at least that much overweight 30 out of my 46 years. I talked with the gastric bypass specialist and with Dr. Spivak who does LAP-BAND®; both said I was a candidate for either procedure with a BMI of 38 because I have several co-morbundities. I applied to insurance for LAP-BAND® approval but did not send an internist letter. Ins. called today and want his pre-op clearance in 3 days or they will deny. I saw my internist today who again said he did not feel I qualified because I am not morbidly obese. (I informed him I am only 10 lbs away from that category) and that he would not write a "glowing letter" to the insurance co. nor would he "clear" me for surgery because that is "up to" the anesthesologist. I reiterated that he must say I am fit for surgery not whether he feels the surgery is justified or if I am qualified from a bariatric standpoint. Having just gone through the pre-op process last week for my mother-in-law's brain surgery, I told him that the internist has to say I am fit for surgery otherwise the anesthesologist is a moot point. He then said he "may be too busy to get the letter out in 3 days" WHAT DO I DO? Should I ask the LAP-BAND® surgery for a friendly internist who does not know my medical history but who can approve me for surgery? The internist at the hospital asked my mother-in-law some basic history and took her bp and that was it - she was approved. HELP!! :help: :cry :angry

Make it easy for them....I would type the letter for him and take it to the office. Here's what my PCP wrote:

Dear Sir or Madam:

Please accept this referral for patient 3Loves, DOB XXX. I feel that this patient would benefit greatly from bariatric treatment. If you have further questions, please don't hesitate to call. This is not a surgery clearance, merely a recommendation.

I would be furious if my PCP wouldn't give me a letter if I felt as strongly about it as you do. I would move quickly since you have a short deadline. Good luck......I hope you get the letter you need.

The Dr. I am seeing for the LAP-BAND® had a hard copy of the type of letter he wanted, so all my doc had to do was sign it. I would call them and ask their opinion.. good luck

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47lbs lost...... 53 more to go......to reach 100lb loss....

Banded 7/27/06
H316/C269/G199


HAIR LOSS???
http://www.juiceplus.com/+jm57447

Thread Starter

Lo and behold my primary sent the letter out last night! He wrote that he was asked to write a letter in support of bariatric surgery for patient XXX . . ." and then outlined the medical issues I have faced. While he did not say I strongly encourage or whole heartedly endorse, it nevertheless is a letter of support. He did not write anything about clearance for surgery or approved for surgery, just that he supported my request for surgery.

I used Dr. Spivak in Houston and he also had a hard copy of the letter for my pcp to sign.........but I'm with 3loves.......write it yourself and then go to his office and wait/pester if you have to until he has time between patients and have him sign it!!!!

If my primary wrote a letter I don't know anything about it. I called her on my own and she said my plans were fine. I don't think my insurance required it, just getting the info from the LAP-BAND® doctor.

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Dr. Spiegel, Houston TX, 6/13/06
Starting over after EGD; many problems with fills
Fill 2.0 12/31/07

Yeah!! Glad to hear he finally sent the letter.....good for you!! You are now one step closer. Stay strong and don't get discouraged. All your hard work will pay off.

Thread Starter

I wish Dr. Spivak has provided a sample letter for me to take to my pcp. Luckily, pcp sent a letter supporting my surgery. He did not mention medical clearance but I realized from the one of the sample letters you all sent that I did not need such wording as long as pcp showed support for procedure. Keep your fingers crossed all goes well. :clap2:

Thread Starter

Unicare has been wonderful as has Dr. Spivak's office. Unicare has given tentative approval, however, the pcp letter recommending for me for surgery is not a medical pre-op clearance. Luckily Dr. Spivak's office is working with an internist who has scheduled me tomorrow to provide such a letter, and the internist has reduced her fees significantly because she is out of my PPO network. Keep the fingers crossed!

Yeah!!! Please let us know what happens. I feel like you will be approved shortly. Then you will be a member of bandland!!!!

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Dr. Benevides, Richardson, TX
Surgery Date June 5, 2006
Proud Member of Jacks Harem
7/11 .6 cc 8/2 1.2 cc 12/26 -.4 cc .8 3/12 +.6 cc 1.4 4/9 +.3 cc 1.7 5/3 -.4cc 1.3 6/12 +.2 1.5 6/27 +1 11/07 Total unfill, band slip... 12/07 +1 1/08 +.5 = 1.5cc

sorry posted without finishing

I do not know what kind of Doctor your primary is but if I were you I would change as soon as I got a chance. Clearing for surgery includes blood work (including pregnancy test etc), chest x-ray and EKG. Depending on your medical condition(s), other tests may be performed. His clearance should include the facts, i.e., BMI, years overweight, diets tried, etc... AND not his pure opinion when facts state otherwise. His telling you that the anesthesiologist is the one to clear you is ABSOLUTELY WRONG. The anesthesiologist will go over your chart with you in the pre-op room and he will ask you a series of questions - Have you ever had anesthesia before?, Did you have complications?, etc.. He will make sure that what you tell him has been documented in the chart and that your primary requested all the appropriate tests.

Thread Starter

Dr. Spivak sent me to a wonderful internist in his building with whom he negotiated a lower fee since the doc was outside my ppo plan. She passed me with flying colors and faxed the pre-op medical clearance on Friday. I'll call tomorrow to see if they reopened my case and if they will issue the approval. :) :) :)