Question:
Am I going about this in the right order?
I asked my PCP months ago if he would give me a referral to a WLS surgeon and he said he would as long as the surgeon was in my ins. co.'s network of providers. So then when I was ready I called the surgeons office to get the consult date, but since the actual appts not for several months I haven't called my PCP back to actually get the referral. Now I'm starting to think I should go ahead and start making the appts now for the psych eval and nutrionist eval that I have since found out my surgeon will require so that I can have as much info in hand when I meet the surgeon the first time. So should I contact my PCP now and let him know whats going on and ask him about referrals to a nutrionist, and psychologist for the evals, etc? I'm beginning to think i "put the cart before the horse" so to speak when I made the surgeon consult appt without notifying my PCP first. What do you think? Also, from all the research I've done about my ins. co. it seems they will readily approve the surgery as long as it is medically necessary, so I'm pretty sure I'll get approval if the surgeon agrees to do the surgery. I've just waited so long already and still have almost 2 and 1/2 months to go before my initial consult appt. I want to do everything I can to speed the process up but I also don't want to have to pay for anything tests, etc. that I may not need. Please give me some advise. Thanks — Elva C. (posted on February 19, 2002)
February 18, 2002
Hi. Congrats on your upcoming consultation with the surgeon. I wouldn't
wait until the last minute to get your papers in order. Taking the time to
do it now will possibly prevent any mishaps in the future. Good luck and
again congrats on your upcoming surgery.
— Jennifer H.
February 18, 2002
It's a lot easier to get in for a psych. eval. / nutritionist visit than it
is to get into a WLS surgeon. I think you did fine making the consult
appt. before you had actually received a referral from your PCP. He/she
probably doesn't care. No, you're not putting the cart before the horse.
I did the same thing.
— Terissa R.
February 18, 2002
I learned, too late, that the referrals for the tests required from the
surgeon had to come from the surgeon's office and not my PCP. I'm still
trying to get my upper GI and nutritional consult paid for by the insurance
company, but I will probably have to pay for them myself. My psych eval
was out of pocket as he was not on my insurance plan. I also had to have
an endocrine consult, but that was handled properly and paid for by the
insurance company. Also, my first insurance company (my husband's company
switched in the middle of my preop process) would not approve or deny the
request until they had the psych evaluation.
I would wait until you have had your initial consult before you do
anything. I ended up switching surgeons when our insurance provider
changed and found that the second surgeon did not require the upper GI. I
also had to consult with his nutritionist, so both the upper GI and
nutrition consult which are pending turned out to be unnecessary. (The
switch in surgeons was my choice. The original surgeon was on the new
insurance, but I did not like the way his office did business, and I
decided to go with a different procedure.) Best of luck!!
— gracie30269
February 19, 2002
I also made my consult apt with my surgeon first once I knew my primary
would supply me with a referal. Once I made my apt with the surgeon I
called my primaries office and gave them the date of my consultation. I had
my referal in hand in case I needed it when I walked into my surgeons
office. I agree with the other folks about your other pre-op
requirements...wait to see what your surgeon specifially requires...it's no
where as long of a wait for those other apts. Good luck! Kim open RNY 7/17
-89
— KimBo36
February 19, 2002
it seems like you've got your ducks in a row! Here is what I did to speed
things up a bit, only to wait, wait, wait anyway! I called for an
application packet from my surgeon's office, filled it out and faxed it, a
few days later I got a letter giving me all the info I needed like whom to
make appointments with, when to do all this, etc. My surgeon has very
specific providers that you must use, then I got the appt with my surgeon
(started in June, first consult in Oct!), went to my PCP for a letter of
medical necessity, then to the internal medicine specialist, the dietician
twice, the two day psych evaluation, a pulmonologist, and had two appts
with the upper GI guy for a consult and endoscopy; then found out that I
needed a sleep study so I made that appointment two months out! Believe me,
it takes a long time in a larger city to make all of your appts and have
all the paperwork sent to your surgeon. Feel free to read my profile for a
complete timeline. It's now the end of February and I have been denied
once for Lap-Band as my ins co only pays for RNY. Whew--it's been a ton of
work but I know it will be worth it in the long run!!!!! Good luck!!!!
Keep your profile current for yourself--it's a great way to keep track of
your life!!!!!
— jenn2002
February 19, 2002
When I asked my surgeon what I could do while waiting for a consult, he
said I could ONLY go for hte psych eval. and work on documenting my diet
history. You have to have the referral in your hand on the day of the
appointment for the surgeon so that's ok. Now, I had my consult with the
surgeon and I am scheduled to see my PCP for a pre-surgery physical (and
letter of rec) and the psych. After that, they will go to insurance and
WHEN (hehe) I am approved, I can then go to the nutritionist and physical
therpaist they require. Check with your surgeon's office. They will be
able to help you with the process.
— emilyfink
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