Question:
Need advice - sorry it is so long.
I'm pre-op (waiting for 1st consult) I have the surgical consult appt and called my PCP to get the referral he wants me to see an Endocrinologist first. My insurance doesn't require a referral if the surgeon is in network so I'm going to keep my appt date, but am worried that my PCP will not approve the surgery no matter what the surgeon says. My PCP hasn't actually said he won't approve the surgery but I get the impression by his attitude that he doesn't approve of WLS. Should I begin looking for another PCP now or just wait to see what happens? And also, if my surgeon says the surgery is medically necessary will my insurance, United Healthcare Select POS, approve the surgery without a letter of medical necessity from my PCP?? I know someone else at my office with the same insurance I have who is seeing the same surgeon I am so I will ask him who his PCP is when I see him at work, but I'm afraid if I do need to change PCP's that it's just going to slow the process down and I've already been waiting 8 months just to get the initial surgical consult appt. Please give me some advice. — Elva C. (posted on April 18, 2002)
April 18, 2002
Don't worry! I have UHC POS and my PCP knows nothing about me even having
the surgery!! Seeing a Endo. will only make the ins. co. look like you have
tried everything that you can to loose weight without having the
surgery.And it will prove that you could be or maybe are diabetic. I had
absolutely no trouble getting approved. Let the surgeon's office handle
everything and go from there. If you think that your PCP would not support
you, then find another that will.
— Amy M.
April 18, 2002
I would also make it EXTREMELY clear to your PCP that you ARE going to have
this surgery and you certainly hope that he's more then willing to help you
in getting this approved and also with the after care. This way your
feeling him out before even asking him to write any letters in your behalf
to the insurance company. If he then tells you that he doesn't believe in
the surgery, I would tell him then I guess it's time for me to find another
PCP who will!! This is a business for doctors too. Most can't afford to
lose patients and should be willing to help you in any way they can. If
they have a negative attitude just because of your weight and thinking you
can diet rather then have surgery, I don't think I'd want them in involved
in my care at all.
— Patty H.
April 18, 2002
I was really afraid my PCP wouldn't accept the surgery either. He has
never told me to lose weight before, and doesn't really mention that I am
obese, i had to find out on my own my BMI. And he also did not want me on
Meridia, my parents had to beg him to put them on it. But i brought in a
letter stating everything that i wanted to do and talked to him about it,
and to my surprise, he was gung-ho for it! he believed this was the only
thing that would really help me after conventional tries at weight loss.
Just ask, i was always told that more doctors support the surgery than
people think. if not, the find another PCP, but i would try yours first.
Sorry, i cannot help you with the insurance part, i have AETNA, but i do
know that not all insurances need a PCP letter, but it helps. Goodluck!
— Lezlie Y.
April 18, 2002
Call the surgeons office and talk to the person in charge of insurance. Ask
what your insurance requires for surgery. I called, and I didn't need PCP
approval and my PCP doesn't even know I'm getting it done. My health
decision are mine to make. By the time I had my appoint with my surgeon I
had everything all together (diet history, family history, physic. eval,
and copy sleep apena results) and they filed that week for approval. If you
have to have PCP approval, ask the surgeons staff what doctors are WLS
friendly and go see one of them. I had a friend who did that and loves the
doctor she was referred to. Best hopes and prayers.
— Cheryl S.
April 18, 2002
I have the exact same insurance as you, and you DO NOT need a PCP referral.
That's the great thing about this insurance, in my opinion. I made an
appointment with a surgeon in my network, and I'm now less than 3 weeks
away from surgery. I did not have to fight with the insurance company at
all--it was entirely hassle-free. And my PCP has no idea I'm having this
surgery. Of course, she will be notified, and I will expect her support,
but I didn't have to get her approval beforehand. Good luck!
— Kristie B.
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