Question:
I need this surgery desprately. Where do I start? Do I go to my family Dr.

and have her recommend me, or do I find a Bariatric Surgeon on my own? Do I see the Bariatric Surgeon and have them file for insurance approval, or do I start the process myself first? I was denied approval approx. 1 1/2 yrs ago. I want to do everything right this time for every chance at approval. Any help will be appreciated. e-mail [email protected]    — Mary B. (posted on May 16, 2001)

May 16, 2001
Depends...do you have an HMO? If so you can't do anything without going thru your PCP. I have a PPO and I do not need referrals to go to specialists, however, I know for this surgery my insurance wants past diet history physician monitored so I went to my PCP for referral letter. He wrote me a great letter stating that I understand what I'm getting into and what different diets I tried and did not succeed at, and how he thought this surgery would help me with the co-morbidities, etc. He was great, I didn't even have to tell him what to put in the letter. It is usually needed to be included with all the other paperwork your surgeon sends your insurance co for approval. Yes your surgeon will send everything to your insurance co. Although some (not many) insurance companies don't even require paperwork, they approve right over the phone to the surgeons billing dept. I tried to start things off on my own with my ins co...they were not pleased about that at all. They don't want to hear anything from me, only the surgeon and any other physicians. So I guess it depends on your individual ins co.
   — Karla K.

May 16, 2001
I would start by finding out about your insurance. Some require a referral from primary, some do not. It would also behoove you to find out about the coverage for WLS surgery and the criteria. Mine is a PPO and does not require referral, but did want a letter from physician stating you have been unsuccessful in past convential diets. Once I knew what the insurance would require, I just set about gathering everything (i.e. letters), and booked appt with bariatric surgeon.
   — danirat

May 18, 2001
I would first start with finding out if your insurance will cover this procedure. If it does find a surgeon that will accept your insurance. Make an appointment with the surgeon or go to a seminar on gastric bypass surgery in your area. Go to your family doctor and get a referral for the doctor you have chosen.
   — blank first name B.