Question:
I am wondering if someone can give me some advice on how to address my pcp.

I posted a question about a week ago about my pcp being very negative and stating he was going to put in a request for authorization for a referral to Dr Jay at NeWeigh. It has been almost a week and I got one call from my Drs office stating that they handnt heard back from Aetna yet regarding the referral. I called Aetna to see if I could check the status of that and the lady I was talking to said there should be no reason for the pcp to be requesting authorization for a referral as long as the specialist is in network, which he is and she said she had no records of his request. I am not sure what I should do now. Continue to wait or call them and tell them that I know you dont need authorization to refer me? Any advice would be appreciated.    — Tanya P. (posted on November 1, 2000)

November 1, 2000
I think you should call and ask for a clarification about the procedure. Tell them what you were told and if you can ge the referal done today.
   — Lisa W.

November 1, 2000
It is hard to answer your question without knowing more. Do you have a copy of your health plan? Does it say anything in it about treatment for morbid obesity? Please give more info and I will try to help.
   — Kathleen K.

November 1, 2000
Normally your pcp still has to get a referral from your insurance company for a specialist. In network just means the specialist can be seen and paid for by your insurance company. But the pcp still has to evaluate you to see if a specialist is needed. But you do have to stay in network for the insurance to pay. This is the way my insurance works maybe yours too. Hugs maggie
   — Margaret S.

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