Question:
Do I need to see my Primary doc to get a referral for WLS?

Can I just make an appointment with a weight loss doctor or do I need to go through my Primary physician? I have Pacific Care HMO in Santa Cruz, Ca.    — mendy (posted on January 1, 2004)

January 1, 2004
Mendy, my insurance required a referral from my PCP to a in-network surgeon.
   — Patty.W

January 1, 2004
It will depend on your insurance. Mine was a standard PPO policy that did not require a referral. Just give them a call and ask. I also called the surgeon's office and asked what the CPT code is for gastric bypass surgery, then called my insurance to ask if it is a covered procedure before I even made the appt with my surgeon.
   — Happy I.

January 1, 2004
I have an HMO (Kaiser) and my first step had to be a referral from my PCP to whomever they refer to. I assume it was the doc in charge of preventative medicine in my area because that is where I was contacted from. I am working on getting approval from Kaiser so I am just on the other side of where you are now. I was referred in early Nov. did some labs and a psych test in mid Nov and have an appointment for an orientation appointment in late Jan at which time I will find out how much more I need to do.
   — John O.

January 2, 2004
Call the number on the back of your card and ask if you need referrals to see specialists. Most true HMO's will require that, but not always.
   — RebeccaP

January 2, 2004
Hi, I used to work for a medical billing company. And HMO's always need a referral from your PCP. If you don't get one you'll be the one stuck with the bill. I had my first consult and per my EOB sent to me by my ins. that consult cost about $400. Hope this helps, and good luck on your journey.
   — vllgmz4

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