To journey to approval
Hi everyone my name is chrlsea, I'm 25 years old from central florida. I have recently started my journey to approval for a vsg wls. I just have a question that's been on my mind, I have thus far attended a information session regarding the different types of surgery and met with a nice surgeon in orlando at this meeting. My question is in regards to getting a pre certification/ pre authorization letter from a pcp... I don't really have one(pcp). I haven't been to a doctor in about 5-6 years due to not having insurance and just being plan scared to go, I am having to find a new pcp whom accepts my insurance in order to continue my journey. I of course will be having my medical records sent over from the office I have gone to since I was young( who doesn't accept my insurance :() but I am hoping someone here can help me as far as trying to figure out how I should go about letting the new doctor know that this surgery is what I feel is the best thing for me, any tips? Thanks everyone I hope to learn a lot while I am here!!
Before I would do ANYTHING, I would clarify with your insurance company if you NEED to have a letter directly from your PCP for approval. I would call the number on the number on the back of your card and talk to someone from member services about your policy and benefits.
For instance, I haven't been to my PCP in 3 years. I was in the process of looking for a new PCP because of an medical incident in my old one's office with a nurse. I was given a shot that caused damage to my upper shoulder/ arm and I had to go thru physical therapy and go to a a shoulder surgeon. The physical therapist even thought I was going into frozen shoulder. My PCP did not believe me at first that anything was wrong after the vaccine was given. She just kept saying I slept on it wrong and wanted to pump me with pain pills and muscle relaxers! I couldn't even move my arm! So needless to say, I did not return because my faith in her was gone.
My insurance company did not require me to even have my PCP involved. I do not even have one listed on anything from the start. For my program at Cleveland Clinic they still require you to see one of their Nurse Practitioner's at the beginning of the program for a physical. Then before surgery, you meet with a Medical Doctor at the clinic to clear you for surgery. I will be meeting with him on Thursday. This is even if you have a PCP, because my mom had her surgery there 2 years ago and did the same thing. She had a PCP and they still made her do the same process. So I don't think it matters!
I am sure every clinic/ hospital does thing a little bit different so I would ask your place directly what they want exactly before you do anything on your own. Plus I would make that phone call. In the mean time, you might want to start touching base with people in your area, trying to find a great PCP! You will need one in the future, I am sure. When you do go to talk to your new PCP also, just speak up and just tell them you will be having WLS and you need a pre approval letter ( if is that is indeed what you need from your insurance) and you would like it from them. I am a firm believer if we don't advocate for ourselves, no one will!
Good luck with your journey! I know at times, I thought I would never get to where I am now. ( I am on the PRE-OP diet! Surgery on the 17th!) Some days were dragging on, however it does allow you to get your mind in the right place. Use this time to read and learn a lot about the surgery. Make sure this is the one you want and the life style you are ready for since there are lots of others also.
Thank you for the response! I actually found the specified insurance info for the weight loss surgery and it never states it has to be a PCP, so I am hoping my surgeon would be able to make the recommendation. I think I will just meet with my surgeon for the consultation and see what they say I need since they definitely know what to ask the insurance company when I don't!
Ask the surgeon which PCP he recommends (someone who commonly refers patients to him) sort of reverse the process.
I notice you are from Orlando... I'll (and a bunch of other people) be in your area in September at the Your Weight Matters National Convention. You should make plans to go. You will learn tons!
Best wishes to you!
~Michelle "Shelly"
