Insurance Question

I am trying to get all my paper work in order so when I have my next appointment on April 4th it can all be submitted to insurance. Here is the question. My OBGYN is the only doctor I have seen in many years and not very regularly. I have spoken with him and he will only put that I have been overweight for many years. I have an appointment with a PCP on Tuesday. Has anyone ever had a brand new primary give a letter of support? He was recommended by the surgeons office. I have BLue Cross Blue Sheild Excellus Insurance and I think I have met all other requirements. I have copy of what is required and I went over everything but I need a letter of referral. Any help or suggestions would be appreciated Lara

Hi Lara I had BC/BS Excellus when I began this journey. They are very receptive as long as you have met all qualifications. I also had a new PCP. Unless, they have changed since January, they approve in less than a week. Of course, before anything was sent to them, I had my consultation with the surgeon, met with his staff for intake, had a physical and received medical clearance from my PCP. If everything is in order, you will have no problem. My surgery was cancelled as my insurance was changed on 3/1 to Aetna who would not authorize surgery even though BC had found it medically necessary. Some insurance companies are changing their criteria so that you have to have a 6 month supervised nutrition and exercise program prior to surgery date. With Aetna, you must have documentation of this during the past 2 years before surgery. I am now waiting for their decision on the documentation the doctor has sent to them. Good luck with a speedy approval. Keep us posted. Keeping you in my thoughts and prayers. Brenda

Thank you for the encouragement. I also have Dr. McKane, so I have done all my appointments so far except for the physical with the PA which is on the 4th. I go see Dr. Burke the primary that they recommended so I hope he will offer me a letter of support. We are just basically going on family history and/or borderline for diabetes, high blood pressure, sleep apnea, heart disease, cancer. It is making it difficult because I am currently healthy just borderline. I will keep you posted on how everything goes. Good luck to you... Think positive (easier said then done LOL) Lara

Hello Lara! I actually had a PCP that didn't agree with me having this surgery so I switched to a new PCP that I new through word of mouth that supported it. I saw him and he recommended it to me before I even asked, we both agreed on it. We ran the tests and in less than a week of seeing him for the first time, he had me scheduled with a surgeon. I got very lucky. I too have BC/BS but I have Traditional blue. They had no problems approving me, actually within the week it was sent I was approved. Everything has gone so smoothly for me and I am really lucky. So, I've had no problems with getting a refferal letter from my new PCP, or BC/BS complaining about it. So..You should be fine. Good luck to you and God bless!!