Question:
Does anyone have know how I can get my pcp to give me a medical clearence
My pcp has written a referral and recommendation for surgery, but says her office does not give medical clearence for surgery, that is what the pre-op should be for. my insurance is requesting clearance and sleep study before approval. — ann J. (posted on January 31, 2003)
January 31, 2003
I don't understand (or should I say that your PCP does not understand).
Medical Clearance is basically your PCP running simple tests (an EKG and a
breathing test for example) to make sure that you are healthy enough for
any potential surgery. I believe your PCP is thinking that they have to
write a letter on your behalf stating why they think you should have this
surgery. Not the case at all. Clearance is just that...you are clear to
have this surgery. Try explaining that to them and if that doesn't work,
call your insurance company and seek other options. You may get someone who
understands. Best wishes to you.
— Tonya H.
January 31, 2003
Ann, the last poster was correct. Your PCP does not approve the surgery
your surgeon does, all the PCP does is send your referral for the surgery,
and that your records state you quailify for surgery, and he/she approve
for you to proceed. If you get the approval from your insurance company,
the surgeon can RED LIGHT the surgery, I think your PCP's office isn't
clear on what you are asking.
— cindy
January 31, 2003
It is me again, I just re-read your question. Your insurance company is not
approving your WLS without certain testing. First, you got your referral
from your PCP, now you need to call your insurance co. and ask for a list
of surgeons in there network, pick your surgeon, go to the surgeon, he/she
will send you for any test that need to be done, example, sleep test, psch
eval, etc. They will know what your insurance co. requires, then the
surgeon submits to your insurance co. after all required test, and if the
surgeon gives it a green light, so your PCP office is correct they do not
submit the surgery release your surgeon office will. Sorry, I did not read
your question correctly, I wish you good luck with your journey.
— cindy
February 1, 2003
Hi, When I went for my consult and was given a surgery date, my surgeon
asked me where I wanted my pre-op testing done. he said that doing it at
my PCP's office was ok, so that's what I'm doing, but I get the feeling
that he would have arranged it for me at the hospital if I needed that
option.
— Fixnmyself
February 4, 2003
I had the same thing happen to me. And your PCP is correct! I was just
lucky enough that my PCP agreed to write the letter and phrase it in such a
way as to clear me for surgery but place the responsiblity in the hands of
the surgeon so that the surgeon is still responsible for doing the pre-op,
which of course he/she will do. My PCP explained it was just a way the
insurance company is trying to see just how many hoops everyone would be
willing to jump through! Good luck!
— nehdeh
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