NEED HELP!!! Blue Cross Cali HMO

 I finally got my PCP to give the referral to the surgeon last week, only took 7 months and two psych evals. heres the issue NOW  the surgeon he is sending me to ONLY does RNY and LapBand. I am going to get either DS( two part) or VSG. I have called BC they say ONLY the PCP can refer me to someone else. He says they ONLY refer to this place.  I have a few options, none of which I care for really...... Get the RNY with his referral get the consult and demand a second opinion in which I have more choices on surgeon, this is done direct through the insurance. BUT the earliest appt is NOVEMBER 26th. Switch PCPs on the 1st of the month and start back at square one. or self pay Is there anything legally I do to force someone to take action faster ? would a letter froma  lawyer get anything done?

thanx for time in advance

It sounds like your PCP does not want to refer to anyone they doin't know. You might try getting a list of surgeons from BC who they will cover who do the procedure then reseach and choose one. Then present that one to your PCP in asking for the referral. If you can tell your PCP the surgeons qualifications he may then write the referral.

If the RNY is not for you then switch PCP's. I would call around and find a PCP that is weight loss surgery friendly (make sure you ask) and get all the copies from your present and past PCP's to give to my new PCP. If you have taken any tests those can still be used. As long as the new PCP is weight loss surgery friendly all they will need is to see your medical history, physical with new physician, to get a referal to a new weight loss surgeon. If you have already found a WL surgeon, you may want to ask ahead of time if the PCP would have any problems referring you to a WL surgeon of your choice. Do you already know of any DS or VSG surgeons who are in-network with your insurance? I would find out that information, too, so you can ask for a referral to see them because your new PCP may not know of any DS or VSG surgeons. Also, since it takes so long to get an appointment for a physical (usually 3-4 weeks), as soon as you find your new PCP, make an appointment for a physical. Right at the time I started to get serious about having WLS, I had to switch insurance and since my PCP did not accept my new insurance, I had to start with a new PCP. I called around, found a weight loss friendly doctor, and the rest is history.  Have you explained to your PCP that the WLS you want is not available through the surgeon they are sending you to? Maybe if you find a DS or VSG surgeon, your current PCP may refer you to them.

 FOLLOW UP  contacted the VSG surgeon I have been talking to , they are both in network and can take referrals from my PCP. Called his explained the situation adn the differences between the different procedures and ask for a referral to one of the others, he agreed to do it, looks like we will be ok.

thanx