How can I get a letter of recommmandation from my surgeon if my surgeon says I need to contact my in

My PCP referred me to a Surgeon here in Kansas City named Dr. Thomas Helling. Dr. Helling is in my Network for my Insureance which is Principle Financial group PPO. I called Dr. Hellings office, and they told me I needed preapproval from my insurance first. So my question is, How can I get a letter of recommmandation from my surgeon if my surgeon says I need to contact my insurance copmapny to get approval first? This makes absolutely no sense to me.

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