PCP Technicality

nikkemo
on 5/11/07 3:33 am - Orange, CA
Has anyone been rejected by their insurance or bariatric program coordinators on the basis of not knowing your PCP long enough.  I have been a member of Kaiser since 2002 and have had the same PCP unitl she left Kaiser in 10/06.  She agreed to do my referal and it was submitted to the coordinators but rejected because it was incomplete.  At the same time I was undergoing a breast reduction(9/06) and while home recovering, she left.  So I decided to heal from my surgery before trying to undergo another one.  But now I have been rejected by my newer PCP becuase he feels he doesn't know me plus I moved to a new city and should get to know my new PCP here and try for the referral.  I meet Kaiser qualifications for the program now, but the hold up is getting to know my PCP.  does that seem right.  I understand why you should have a PCP and have meet with him/her before but why should I have to go through another 4 yrs of knowing my PCP before requesting a referal because the one I knew and trusted left me out to dry. Is there something I can do to get around this. It just doesn't seem fair. Nikki
(deactivated member)
on 5/11/07 3:10 pm

choose another pcp and keep going untill you find one that is more excepting of wls, i hadnt had insurance since i was 12 and as soon as i got it i started looking into wls and my pcp was behind me 100% and i got the refferal at my first consultation with her. Get a copy of you're medical records and bring them with you showing that you have looked into this surgery before and the pcp you had for so long was behind you. I would go right in the first meeting and let them know that you've made you're decision and you are looking for a dr who will be supportive, if they arent then  you keep looking. Unfortunately you never know whats going to happen you could see this pcp for a year and then all of a sudden wls is no longer covered under you're policy, i wouldnt wait around untill this dr feels more comfortable about your decision i'd go somewhere else. goodluck!

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