Question:
Do you have to have a PCP to get approved?

I dont have a regular doctor, i've moved 3 times and i really only go when im deathly ill, so i've seen a few different doctors. I DO go to specialists for my thyroid,insulin, PCOS, GERD, asthma etc. but no PCP. Do i need a letter from a PCP to get approved my Medicare?? I have a new PCP i've seen twice, but he says he doesnt deal with weight loss issues, so he says he cant write me a letter.    — MelissaSue83 (posted on May 8, 2009)

May 7, 2009
Most of the insurance companies require you have a minimum of a 6 month consult with a pcp(once a month). What the pcp does is monitor your weight and your progress. There are other things that the pcp does such as referalls for a cariologist. The wls surgeon needs to know that your heart can handle the surgery.
   — Kathleen W.

May 8, 2009
I dont have a PCP, but I do have an endrocrinologist that I have been seeing on a consitant basis. He was the one that recommended me, and when my insurance company required the 6 month supervised weight loss, he was more than willing to have his nurse do my weight. When I was finished he wrote up another mail and I got approved. So check with your specialist. Sometimes they recommend it more then your pcp will.
   — Melanie S.

May 8, 2009
I don't know the answer to your question...but I did want to say that if your new PCP doesn't deal with weight issues, you need to get a different PCP anyway! Being overweight, you need one that is willing to DEAL WITH WL issues! His comment made my blood boil, to be honest...I'm so passionate about these sort of things...I cannot believe the crap I put up with from PCPs and now that I am thinner, I realize how bad it really was and how I didn't say anything because I was intimidated by my weight and how people treated me...Find a PCP with compassion and an open mind for all people fat and thin...HUGS! And good luck with your journey!
   — .Anita R.

May 8, 2009
I don't think you *need* a PCP to get approved. My surgeon wrote my prescriptions/gave me referrals for all of the tests that I needed - e.g. cardiologist, pulmonologist, hematologist, etc. You should call Medicare and tell them your situation and ask if they require a letter from the PCP. (My insurance did not require it.) You might also want to call the place where you are considering having surgery and ask them whether you must have a letter from a PCP, that way you can go ahead and schedule that appointment because sometimes it takes a few weeks to get into a PCP if you don't have an urgent matter or current sickness. I agree that you should get a new PCP, because you will want someone who can support your weight loss efforts.
   — ads2e

May 8, 2009
Most insurance companies require you to have a Primary Care Physician - at least for consistancy of care and to be a "centralized" place where copies of all your records and tests are kept. And most insurance companies are going to require you to have between 3 to 6 months of a physician supervised weight loss program documented - with monthly weigh-ins and documentation of what diet you're doing and how effective it is, and so on. Your PCP can also get you referrals or give you the names of specialists for tests that your WLS surgeon is going to request be done, like pulmonology testing, EKG or Echo-cardiogram, Esophogastric testing, psychological testing, etc. Of course, your surgeon can do that too... but it's a good bet that he wouldn't be able to write a letter of "medical necessity" for you (having not known you for many years). As Anita says, I'd find another PCP fast. Your weight is one of your biggest health problems, and if he or she can't or won't deal with it.... that sounds like a malpractice or malfeasance condition to me!!!
   — Erica Alikchihoo