Question:
Do I need a PCP Referral to get an appointment with a surgeon?

Can I make an appointment directly with a surgeon or do I need to go through my primary doctor to get insurance approval? If so, any suggestions on a doctor in Sacramento area that will refer me out? Anyone had a doctor that has refused a referal to s bariatric surgeon?    — Heather A. (posted on April 27, 2002)

April 27, 2002
It depends on which type of plan you have HMO or PPO? If you have an HMO, you will need a referral. And, yes, your PCP can refuse to refer you. I asked my ex-PCP about WLS a long time ago and he said ABSOLUTELY NOT! I just gave up the idea until about a year later when I could stand the co morbidities no longer. I switched to a PPO plan during open enrollment. If you have a PPO, you can go to a surgeon without a referral. If the surgeon is "in-network" the ins. co. will pay more. If not, they typically pay around 70%. In the end, my military ins. covered it. (I'm a retired AF Veteran) Good Luck! PS If you do have an HMO and your PCP refuses to refer you, you can always look for peers (go to AMOS "find peers") in your area and ask them to refer you to a WLS friendly PCP. You can just change PCPs whenever you want.
   — Karen B.

April 27, 2002
My bariatric surgeon does not require a PCP referral. In many cases, it is the insurance companies that will dictate whether a PCP referral is required. Because I had had the same PCP for over twenty years, I felt that it was important to discuss with him my decision to have the RNY. Being the very conservative internist that he is, he immediately took a very negative attitude regarding my decision and tried valiantly to change my mind. It was at that point that I explained to him that although we had had a long and positive relationship, I WAS going to have this surgery, and would need a physician that was willing to collaborate with my surgeon for after-care....if he didn't feel willing or capable of doing that, could he recommend a few other good physicians or groups in town? He immediately backed down, asked to see all the written information that I had about the surgery, phoned the surgeon directly for more information, has been very supportive since my surgery 25 months ago, and now regularly refers other patients for WLS. Many times, PCPs object to WLS because they are completely "ignorant" about the process in general, as well as what will be expected of them in the after-care stage. Many of them only remember the "old" gastric bypass surgeries which were generally unsuccessful long-term and involved high mortality rates. If your PCP is willing to be educated, fine.....if not, please remember that there is more than one competent physician in town, and start shopping. Good luck!
   — Diana T.

April 28, 2002
If you have an HMO you definatley need a referral. It's probably a good idea either way to talk to your PCP. You may need a good PCP for support (ie: letter of necessity).
   — emilyfink

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