Insurance question

I posted a question in the other forum but haven't gotten a response. I'm really worried. I have Aetna (soon to be COBRA) and there is a PCP requirement that I can't fulfill and was told wouldn't be an issue but I read a post where someone said they were denied without it. I have never had consistent enough Insurance to have a PCP once I became an adult. Is this something I can start now (I'm only 3 months onto my 6-month insurance required prep time) And how long can I wait after I've had my EKG and other testing before my Insurance makes me take the tests again?

I seem to be coming up against one obstacle after another trying to get this surgery done. All I want to do is save my life. 

I would suggest that rather than rely on what you have read here or have heard from anyone that you call your insurance company and ask for their specific requirements for WLS in writing.  Good luck!

If your plan requires a PCP you can start going to one now.  If that is a requirement and you don't have the PCP referral they will not pay for your surgery. 

You are going to need a PCP anyway.  That doctor will handle routine care non-surgery related.

Find a PCP now and get in ASAP.  I had my surgery under Aetna, and when I called and asked specifically what they were looking for in the PCP recommendation, they said just wanted a statement that I didn't have any medical conditions that would make surgery questionable, that I had been overweight for years (I think my plan required weight for over 5 years), and that he felt that surgery was my best chance for obtaining a normal weight. 

As far as the tests, you should ask your surgeon's office, but my surgeon didn't order any of the pre-op tests until AFTER I had completed all the other requirements and was approved by the insurance company.  That is also what the surgeons that I work for do, because insurance companies often won't pay for the EKG, ultrasounds, etc. when their only purpose is pre-surgery if they have not already approved the surgery.

Lora

What Lora said. I am glad my doctor used to march my butt out to the scale when I refused to get on it. If he didn't I wouldn't have had five years of weight records. 

MAybe I am misunderstanding your response, but if she submits the request for approval to Aetna without the PCP recommendation letter, they will deny the request and then she will have to go through the appeal process...

Lora

Not always!  Besides, the surgeon's office isn't going to do the work to get the letter from the PCP.  If the insurance requires a PCP recommendation and none is submitted, Aetna (notorious for denials for missing papaerowrk) WILL deny it.

It is much easier to be sure everything required gets submitted the first time than to go through the appeals process after an initial denial!