Question:
PCP Referral Beofre Anything???....

Hi Everyone! I have my evaluation for gastric by pass surgery in August But before I go Should I have a PCP Referral or just make the initial consultation on my own?? Please anyone.... Respond....I would greatly appreciate it!! Vicki    — Vicki R. (posted on June 22, 2002)

June 22, 2002
Vicki, It depends on your insurance. If the surgeon charges for the initial consult, and your insurance company requires a referral, then I would definately get one.
   — maryburton

June 22, 2002
I never had a PCP referal. As a matter of fact, my PCP was so against the surgery! So I researched the doctors in my area for this type of surgery (rny) and made my own appointment and the surgeon took care of everything else.
   — Rebecca G.

June 22, 2002
Vicki, My insurance company does not require that I have a referral to see a specialist. Therefore, I did my research and made the appointment on my own. My PCP doesn't even know that I am having it done, although he will find out next week when I see him for my pre-op physical-LOL! Best of luck with your process!
   — Heather N.

June 22, 2002
Personally, I would ask your PCP to write you a letter of medical necessity. This HAS to count when your insurance is looking at your request. I mean, if a doctor, in their network says you need surgery, who are they to question that? It certainly couldn't hurt, and may very well mean the difference between approval and denial.
   — Greg P.

June 22, 2002
I would get a referral before I did anything. That way you'll be sure to be covered by your insurance. Like they always say, better safe then sorry.
   — Amy C.

June 23, 2002
Hi Vicki, Yes, Contact your PCP for a referral. Let them know you have sought out a surgeon and would like to begin the process. Also tell your PCP about your last appointment with the GYN. The more imformation available to your insurance. You stand a better change of getting approval. Good Luck. Aynikaye
   — Aynikaye

June 23, 2002
I saw in your profile that you have medicaid - and I do believe that in most cases they do require a pcp referral for any non-emergency surgeries. Ask your caseworker though to be sure. They're usually pretty helpful.
   — [Deactivated Member]