What PCP does anyone have thats PRO WLS?

Well as positive as my Dr sounded at my appt the other day. I called his offive this morning and said did we get a denial the nurse checked she said yea we got it Thursday. I said ok well do we have a list of the requirments ? She gave the phone to the Dr. He said oh no I didnt get that but it was denied im sorry maybe you should try somthing else. So much for all his help.

I am not sure I understand... is your PCP denying you or the insurance company has denied you? Have you seen a surgeon yet regarding your plans for Weight Loss Surgery? From my knowledge and experience, the surgeon does all the work for the approval process with the insurance company, not the PCP. I only had to get a letter of medical necessity and supervised diet documentation from my PCP and any other medical information to support what my surgeon had put together... I had to provide all the paperwork to my surgeon's office for approval. Let them do the insurance work. You can always call your insurance company and ask them what is required for a Weight Loss Exclusion... usually it is a letter of medical necessity, minimum six months of doctor supervised weight loss, history of obesity, documentation of weight loss attempts (weigh****chers, gym memberships, jenny craig, la weight loss, nutrasystem, etc) and letter of medical necessity from your weight loss surgeon. Good Luck to you!

Well I did call and they said they can't give that to me only to my PCP. But no my PCP said that my insurance gave him the denial.

Your PCP shouldn't be asking for approval from the insurance company. Your Weight Loss Surgeon should be doing that... do you have a WLS surgeon yet?

Julia I live on the Southeast side of Tucson and see Dr. Lionel Duarte on 22nd and Harrison.

Julia, I think the misunderstanding could be with the type of insurance that you have. The access (APIPA) and some Mercy Care and Humana's require an authorization with each and every step that you take in the weight loss process. 1.. auth to actuallly go to your pcp 2. auth from your pcp and insurance (case worker) to go to a weight loss surgeon 3.. auth to go to a psych 3. auth to go to a physical therapist and nutritionist and auth each time you go to the pcp for the 6 to 12 month supervised diet. "If" you endure to the end and turn in all of that information to a weight loss surgeon, THEN they will submit for pre-authorization for your weight loss surgery. Approval is still tentative even though you've fought the big fight! Most insurances can be dealt with directly by the weight loss surgeon's program alone but NOT Access types. It may be that you need a new case worker and not a new pcp if you are reaching a denial already OR you just don't have the qualifications: BMI over 40 or over 35 with 2 or more co-morbidities, good health for surgery, etc.???? Good luck! Joyce

Oh gosh well that does clear up a bunch I appreciate the info my bmi is definately over those figures I have sleep ap, RLS,Joint issues etc.. But I do have good health as far as surgery goes. I did not know i had a case worker for the insurance though I will have to see if I can get in touch with who that is. Thanks again

Julia, When you get all this straightened out, my PCP is very knowledgable about WLS....(she has to be her husband was my surgeon) She is really sweet and very informative. Her office is on Tanque Verde by Catalina Highway. Her name is Dr Tisha Schwartz and she is affliated with Carondelet. Good Luck...this is the hardest part of the whole process. Let me know if you need a "Tucson Hand" Maryellen