Question:
My primary Dr. dosen't approve?????
I have my first appt. with a surgen on1/10. I'm kinda nervous because my primary dr has already told me she would write a letter to my ins. but she would say that she doesn't approve of the WLS. Should I change doctors? How do I find one that will approve? I have a 39.8 bmi, sleep apnea, heartburn, depression and boy do I get out of breath easy. Do I need my primary's approval to get my ins to approve?????? — Genblosum08 (posted on January 8, 2006)
January 8, 2006
If your insurance is anything like mine you will definitely need your
primary doctors OK. I would recommend finding a new pcp, maybe ask your
surgeons office if they can recommend one.
— *Malena* M.
January 8, 2006
My primary doctor didnt approve eather,my surgeon said i dint need it and
he took care of it.I really like my doctor .
— SWEETPEA52
January 8, 2006
My primary doctor didnt approve eather,my surgeon said i didnt need it and
he took care of it.I really like my doctor .
— SWEETPEA52
January 8, 2006
I never needed my primary Dr's approval, of course I have Medicaid also, so
that might be the difference. For me, I went straight to the WLS Dr. and
never had to get permission from my PCP.
Hugs
— Angelfirewithwings
January 8, 2006
My primary doesn't approve of WLS either. What is needed from Primary in
the letter is that you attempted diets. The insurance co. doesn't care of
the Primary's personal opinion.
— NurseTC
January 8, 2006
Insurance approval doesnt rest just on your primary - unless you have an
HMO that you need the primary for a referal. Your insurance carrier is
going to have guidelines - they are looking for that not a letter from your
primary. I didnt even have a primary nor did my insurance ask anything
from them. The surgeons office is the one to decide if you need surgery.
— star .
January 8, 2006
Jennifer,
My primary physician gave me the referral for a consult with my surgeon but
the approval for surgery was based off of the documentation and submission
by the surgeon, not my Primary Physician.
I have a question, did you set-up the appointment with the surgeon on your
own or did you get referred to him by your physician? If for whatever
reason your physician authorized a referral it is out of his hands anyway.
However, if your insurance does not require a referral for a surgeons
consult but do require some type of approval from your PCP then I would
consider getting a new doctor. He can not submit an intervention if he is
not your physician.
I hope this helps.
Tiffany
— Tiff's On a Mission
January 8, 2006
My primary doctor wasn't in favor of my operation. I asked him why &
he said he had patients come in with problems. I pointed out to him that
patients that didn't have problems with the operation probably wouldn't see
him. He wouldn't have considered writing my insurance company to stop me
& if I were you I'd find a new primary doctor in any event. Jerry
— jerry C.
January 9, 2006
You need a medically supervised diet for 12 months to get approved with
this insurance. They are very picky now opposed to 6 years ago when I had
surgery. I wish you luck.
Dana Estrada
LivLite
— DanaDee1969
January 9, 2006
BCBS Blue Choice required a note from my primary care stating that I was
cleared for surgery. It didn't have to say he approved...but he had to be
willing to write the note stating I was 'medically cleared'.
— mmcphee1
January 9, 2006
Jennifer,
I don't think the PCP is suppose to give his/her personal opinion on the
matter. The point is, will having WLS relieve you of sleep apnea,
heartburn (which could turn into a hyernia) and depression? That is what
he needs and all he needs to put in his letter. Much Prayer.
— the7thdean
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