Question:
Who submits to approval....you, PCP, or Surgeon?

I have not seen a doctor regarding gastric bypass. I want to be approved by insurance co. before seen a surgeon. Who submits letter to insurance for pre-authorization..... me, Primary Care, or does the surgeon who does the surgery?    — Jeanette D. (posted on May 27, 2003)

May 27, 2003
Hi, Usually you get and referral forn your pcp to go to a surgeon then after the first consult with the surgeon, his insurance person will then send in all of the necessary paper work to your ins. company at least that is how mine did it. Some poeple do already get ins. apporoval for the surgery before they even see a surgeon, but I guess then ;you need to call your ins. company yourself to see what they need from you to get approved or have your pcp do it> hope this helps good luck!
   — Melodee S.

May 27, 2003
Most times it is the surgeon who will submit the information for the approval, since he wants to get paid. It may be unlikely that you could submit anything that would get you an approval before you see the surgeon. You can verify the benefit and see what the criteria is for WLS approval. Then be sure your surgeon addresses the criteria in his letter. Some insurance plans require a letter from the PCP, also. In my husband's case, we submitted to letter of appeal after he was denied, simply because I had more time to put pertinent facts into a letter (I'm a nurse, too),otherwise, the surgeon's office would have submitted that on my husband's behalf.
   — koogy

May 27, 2003
I had to have all of my pre-surgical screenings done and approved my all Drs ( Cardio, Pulminary, gastro, psych, nutrition, etc.) into my surgeon, THEN his office submitted everything to the insurance company. I was approved within 2 weeks of submission. Blue Choice PPO. lap rny 5/15/03 ,-16 lbs
   — KellyJeanB

May 27, 2003
Some ins. doe not require a referral from your pcp. The other posters are right in telling you that the surgeons office will submit your stuff to get you approval. They also know what test to order that you need and etc, The only thing you might do is call your ins. company and see that it is indeed a covered bebfit and if you need a referral from your pcp. If you don't and it is a covered item just call the surgeon of your choice and let them do the rest. Don't get stressed trying to do everything for yourself. I think a lot of people do and it is really up to the surgeon to get everything in order. Good luck!!!!
   — Delores S.

May 27, 2003
My surgeon's office submitted for my approval.
   — Patty_Butler