Question:
Does my PCP get m approved or does the surgeon?

My PCP told me he is looking into getting me approved i thoughtfrst i found a surgon, and then he would get me approved. My PCP told me that he can't give me a refferal until he gets me approved. I dont he will make any effort in doing this anytime soon. so please let me know if you have any advice. Thank you Kaye Hock    — Angie H. (posted on January 23, 2001)

January 23, 2001
In my case, my surgeon obtained the authorization for surgery. My PCP gave me a referal to the surgeon. The surgeon ordered the necessary pre-op tests, did the evaluation and submitted the request to the insurance company. I never had to even call the insurance company. I was approved in about three weeks (and this was over the holidays)! In my opinion, it is the surgeon who has the experience in exactly what needs to be submitted to the insurance company to get approval. They're the experts! But, perhaps it depends on your insurance. Also, it could be that your PCP needs to get approval from his medical group to give you a referal. I had to change PCP's because my first PCP wouldn't give me a referal (said he had never had anyone without comorbidities get approved and that arthritis in my hip was not a comorbidity and it didn't matter that my BMI was over 40). In hindsight, it was probably the medical group that wouldn't give approval for a consulatation with a surgeon, not that the insurance wouldn't approve it.
   — Gina E.