Question:
I need this surgery desprately. Where do I start? Do I go to my family Dr.
and have her recommend me, or do I find a Bariatric Surgeon on my own? Do I see the Bariatric Surgeon and have them file for insurance approval, or do I start the process myself first? I was denied approval approx. 1 1/2 yrs ago. I want to do everything right this time for every chance at approval. Any help will be appreciated. e-mail [email protected] — Mary B. (posted on May 16, 2001)
May 16, 2001
Depends...do you have an HMO? If so you can't do anything without going
thru your PCP. I have a PPO and I do not need referrals to go to
specialists, however, I know for this surgery my insurance wants past diet
history physician monitored so I went to my PCP for referral letter. He
wrote me a great letter stating that I understand what I'm getting into and
what different diets I tried and did not succeed at, and how he thought
this surgery would help me with the co-morbidities, etc. He was great, I
didn't even have to tell him what to put in the letter. It is usually
needed to be included with all the other paperwork your surgeon sends your
insurance co for approval. Yes your surgeon will send everything to your
insurance co. Although some (not many) insurance companies don't even
require paperwork, they approve right over the phone to the surgeons
billing dept. I tried to start things off on my own with my ins co...they
were not pleased about that at all. They don't want to hear anything from
me, only the surgeon and any other physicians. So I guess it depends on
your individual ins co.
— Karla K.
May 16, 2001
I would start by finding out about your insurance. Some require a referral
from primary, some do not. It would also behoove you to find out about the
coverage for WLS surgery and the criteria. Mine is a PPO and does not
require referral, but did want a letter from physician stating you have
been unsuccessful in past convential diets. Once I knew what the insurance
would require, I just set about gathering everything (i.e. letters), and
booked appt with bariatric surgeon.
— danirat
May 18, 2001
I would first start with finding out if your insurance will cover this
procedure. If it does find a surgeon that will accept your insurance. Make
an appointment with the surgeon or go to a seminar on gastric bypass
surgery in your area. Go to your family doctor and get a referral for the
doctor you have chosen.
— blank first name B.
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