Question:
Seeking Those Denied Clearance For Surgery By Their PCP

Scheduled for surgery 6/30/03,Learned LAST NIGHT 6/27/03 PCP will not clear me. My surgery is scheduled for this Moday, my PCP called me and told me he will not clear me because I haven't seen him since May 26, 2003. I have done all my pre-op testing, ins approval, paid my co-pay, all the specialists have cleared me, I have no health issues. My Pcp has seen me all of 3 times period twice for checkups, once for blood work, My surgeon has more info on me than this guy does. Can I do anything about this? Can another doctor clear me based on the info that surgeon has? I have BCBS PPO.    — Mssxyred1 (posted on June 28, 2003)

June 28, 2003
You would probably have to check with your surgeon to see if another doctor could give you medical clearance for surgery. My wife needed medical clearance as well and we simply scheduled an appointment with her PCP for her to be examine and for him to fill out the paperwork. I needed cardiac clearance (no heart problems, but I was SMO), so I scheduled an appointment for a cardiologist to get my cardiac clearance. It was simply another required step. <p> Did you know that you needed a medical clearance for the surgery (it would have been in the list of required tests that your surgeon gave you when he scheduled your surgery)? If so, what was your excuse for not making an appointment with your primary to get this clearance taken care of? JR
   — John Rushton

June 28, 2003
Tangie, this is your little sister here, per our coversation on the phone last night, your insurance does not require a pcp therefore a in hospital dr can clear based on the results of your pre-op testing, if the any of the attending physicans are in network you can even change your pcp w/one telephone call to your insurance company the day of surgery...and one more thing, everything happens for a reason...my surgery was canceled 2wice by two different surgeons for several reasons and took 2 years for me to get to this point..hang in there..luv ya..teal
   — chinadoll_491

June 28, 2003
Who is requiring your pcp to clear you? Mine was not ever included in my wls plans and still does not know i had it. if ins. doesn't require it you don't need him. Just go on and have your surgery.
   — Delores S.

June 28, 2003
Tangie, I have the same insurance as you (BC/BS PPO Federal), and as far as I've always known, I've never had to have any referral to any specialist. I'm in MA, so I'm not entirely sure if the same things apply to both of us, but if they do, I don't see why you would have to have your PCP clear you to go. I would recommend calling the number on your card to find out for sure.
   — sunneegirl

June 28, 2003
it is not an HMO, i was under the idea if you have a PPO- you do not need any type of clearance from your PCP? or even a referal to see any other Dr. (with wls, it helps to have it and a letter of recommendation, but i don't think you have to have it with PPO) I would call your insurance, or surgeon and ask-
   — heather S.