Question:
What are the steps to recieving the ACTUAL surgery?
I am in the process of getting this surgery. I've been researching for way too long and now I'm ready! I am however having a lot of problems obtaining my referral from my PCP. When I first went to see her, she didn't approve of it at all (see my profile), now she's going through the paper work at least I think she is. My question is: aren't you just supposed to get the referral from your PCP to the doctor of your choice as long as he/she accepts your insurance, and then after your consul with the surgeon, then in the office goes through the insurance company for approval? My doctor's office is telling me that the doctor's part is done but they are waiting for the insurance company to respond them? What are the steps really? I have Humana HMO can some one advise ME please? — dainty (posted on July 17, 2001)
July 17, 2001
I also have a new PCP, and have not met her yet. I got her name from this
site, and I hope she is as good as she sounds. Her name is Dr. Janet
Robinson of the Holy Cross Medical group in Ft. Lauderdale. My first appt.
is Aug.27th. Another name that came up was Dr.L. Lambert also from Ft.
Lauderdale. It was posted that both ladies are advocates of the surgery.
Good luck
— angel C.
July 17, 2001
I personally went PCP for referral,saw surgeon,surgeon submitted to ins.
for approval. I never had to see my PCP again and haven't since before
surgery. I would call your ins. co. and find out from the horse's mouth so
to speak what they require and what steps are necessary. THis way if PCP
questions it you can say you already spoke with the ins. co. Good luck
— Linda M.
July 17, 2001
I started the insurance process as soon as I got the referral from my PCP,
because I knew it was going to be a fight with the insurance company. I'm
currently appealing the initial denial (due to exclusion). So, if and when
the insurance company says yes, I know I'll be covered all the way through
the process with no gray areas.
— Rosie P.
July 17, 2001
With my HMO, unless the surgeon is actually a part of the same medical
group as your PCP, the PCP has to request the referral and wait for
approval. In my case, my surgeon did belong to the same medical group, and
my PCP could do an immediate referral (although she did not know that and
submitted a request for an approval anyway). - Kate -
— kateseidel
July 17, 2001
In my case, my surgeon is a preferred provider on my insurance plan, so I
simply made an appointment with his office. Because he is a provider on my
plan, I did not need a referral from my PCP. The surgeon's office handled
the approval and has sent me for all their required pre-op testing. I have
my final pre-ops at the hospital on 8/14 and my surgery is scheduled for
8/22. I saw my PCP just last week for a different issue and was shocked to
find brochures from my surgeon in his office about bariatric surgery. I
was especially happy when he told me that he supported my decision to have
the surgery. Good luck to you!
— Pamela F.
July 18, 2001
I had to get a referral and then all the appt's. started I started in Nov.
2000 and have had all my evals.and nutrition visits. blood work etc. and I
finaly got a surgery consult appt. for Aug !3th 2001. Then thy send for
approval. then I get a date . My ins. has approved everyone I know that has
wanted Wls,So far. I have LaCrosse Care Plus. my dr.s Are at mayo clinic
Rochester Mn. it can be a long process so keep pushing. If you can Try to
book all appts. as soo as poss. and ask to be on waitig lists for every
appt. and there is a chance it will go faster. Unless you get lucky and can
see the surgeon first than it seems to go faster. Good luck.
— Sue R. T.
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