Question:
I don't have a pcp I have a nurse prac. who won't give referal
I don't have a pcp. I go to see a nurse practistioner. She will not give me a refferal to a dr because she says I just need to try more diet and exercise. I am currently 302pds I am 22 years old and have 2 children. I have been overweight all my life. I had my gallbadder removed a few years ago. Do I have to have a refferal by a pcp ? will a dr do the surgery without the refferal ? I has masshealth as insurance. — amy H. (posted on April 16, 2003)
April 16, 2003
Amy - Get a new PCP or NP. I don't know what Masshealth requires for
approval, but you will want and need all the support you can get if you
decide to have WLS. Best of luck to you. Many Blessings, Robin
— rebalspirit
April 16, 2003
My suggestion to you would be to contact the WLS surgeon of your choice and
ask them to recommend a PCP who will give you a referral. It's kind of
like going in the back door but it works! Best wishes you.
— ronascott
April 16, 2003
Amy, I didnt even contact my PCP before i contacted the surgeon. I just
looked him up in my insurance network and went from there. They told me i
didnt need a REFFERAL, since it was elective surgery and was covered by
insurance. But, i did want my pcp to write me a letter and she wouldnt, so
i requested my records instead and i got approved, and i have scheduled my
surgery for june 30, 2003. ( had to wait till after baseball and softball,
i have 3 children ...8,9, and 4 mos.)Good Luck!!
— stefanieulmer
April 16, 2003
All of the surgeon's I looked into required a MD send in a referral letter.
My first PCM would not do it and he couldn't have done it any way he was a
PA not an MD. So I had to find a PCM that would write my refferal letter.
If your surgeon and your insurance doesn't require this then I would just
set up the appointment with the surgeon, and find a doctor that has dealt
with patients after WLS. NP are good for some things but they are not true
doctors and in my experiance less likely to listen.
— S C.
April 16, 2003
Some insurances don't require a referral, and others do. So that depends
on your ins. company. Call them to find out. Second, if your NP won't give
you a referral, and you need one, then research your WLS surgeon, pick one
out, then call the office and ask them for a list of "WLS friendly
doctors". They should be able to help you. My doctor refused to give
me one,(she is 5'10'' and maybe 125 pounds), so I found another who could
help me with my decision that I had made for me. GOOD LUCK!~ Sandy
— Sandy H.
April 16, 2003
First of all a NP reports to a MD and technically that is the person
totally repsonsible for your health care. Even though a NP can prescribe
meds etc. she must be supevised by an MD. So that is your other route, but
I agree with all the othr suggestions. Get a new PCP and call the
surgeon's office to see whom they suggest that is covered by your
insurance. It would seem that you qualify for surgery even without any
significant co-morbs. As one poster said you will need the support of your
PCP after surgery so you might as find one now that is willing to work with
you.
<p>As far as referrals etc. only your insurance company can answer
that. I have a point-of-service contract so no referrals for me and in
surgeon did not even require anything from my internist. However, I did
ask him to write a letter but by the time he got around to it I already had
insurance approval. I just made sure that office notes and lab work from
him and other specialists got to my surgeon so that he had enough info to
write for approval. I have BCBS of WI.
— zoedogcbr
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