Need Help-PCP says 30's are too young for WLS

lovinglife · 11-18-2008, 12:40 PM

My friend had a consult yesterday with his PCP regarding LAP-BAND^®. He is early 30's with a BMI of 39.5%. Has high blood pressure and long history of heart attacks in his family. Many dieing in their 40's.
His PCP told him to walk 1 1/2 hrs a day, keep a food diary and that he would treat his high blood pressure with drugs.
Said he was too young for the LAP-BAND^®. And this insurance covers this procedure!!
--
Now, how does he proceed from here?
Can he find a weight loss surgeon and have them file the paperwork with his insurance? Can he bypass his PCP, or does he have to have that referral?? He is in the Ft Walton Beach, Fla area.
He is devestated.

luluc · 11-18-2008, 01:21 PM

some surgeons do not require PCP approval - but that might be an insurance stipulation & your friend should find those specifics out.

mine didn't find out till after i was banded ; only my OB knew because i was trying to get insurance approval with her help - to no avail; i still went ahead self pay.

30 is NOT TOO young - your friend is obese; no matter what age....taking care of that be it WLS is far better than the alternative with his given medical history.

if he has another dr (for heart/bp/etc) he should get in contact with them to get on board. when all else fails, i've seen people change PCP to GET the approval they need for surgery.

wishing your friend luck!!

whatfolly · 11-18-2008, 09:24 PM

Consider changing to a new primary care doctor. 30's is not too young for LAP-BAND^®...but it is too young to have a heart attack. Good luck and tell your friend to fight for what he wants...his life depends on it!

**MacMadame** · 11-18-2008, 11:51 PM

Quote:

Originally Posted by lovinglife

Now, how does he proceed from here?

He should get a new PCP. Even if his surgeon or insurance does not require a referral from the PCP, there will be things that the PCP has to do -- such as order tests, do a physical -- and if you have a PCP who doesn't support you, they can really gum up the works by being a bottleneck for these things.

Plus his attitude towards WLS stinks!

Shamrockgirl60 · 11-28-2008, 11:45 AM

I would change PCP's asap....get one who is more sympathetic and not so judgmental. I switched my PCP a few years ago and thank heavens I did. My old one probably wouldn't approve of LAP-BAND^® she was a skinny women who said things like "We must lose weight" "We must quit smoking"....I finally asked her what the "We" meant when it was 'ME". She was not amused. I changed right after that, quit smoking and now am losing weight, she does not work at the clinic where I go anymore I can see why. No warmth or bedside manner at all. I would like to find her and go give her a big "Raspberry" LOL LOL

**Jack** · 11-28-2008, 11:48 AM

30s with those cofactors is reason enough to find a PCP who has a different opinion.

pebbles1970 · 11-28-2008, 01:17 PM

Sounds like his pcp needs mental help. I agree with everyone else, find a new doc.

RaRaMba09 · 11-29-2008, 12:05 AM

I am 39 and told to gain more weight. That is when I went to the ObesityControlCenter.com and found Dr. Ortiz (yes, Mexico). He has performed nearly 7000 surgeries. If your friend can suck it up and not do the insurance game, pay the 8k like many do and go over the border.
The doctors and big pharma make it WAY too difficult for people in the US to have WLS here.

good luck