Question:
DO WE NEED REFERRAL FROM A PCP INORDER TO GET INSURANCE COVERAGE?

I keep reading that anyone who's considering WLS must first have referral from a PCP (Primary Care Physician) to the Bariatric Surgery. Is that a requirment by the insurance company? I have Anthem Blue Cross Blue Shield [PPO]. So I don't actually have a PCP nor did i ever require one to seek a Specialist's advice. Can anyone please clarify this. :( Thanx a ton in advance !!!! ~Laura~    — Laura R. (posted on May 5, 2003)

May 5, 2003
I think the answer to your question is that it depends on your insurance. Mine requires a referral from my PCP for just about anything. I've never had a problem getting one. Call the number on your insurance card and ask them.
   — JoSyrNY

May 5, 2003
I did not need a referral from a pcp. I had bcbs of mass ppo and because it is a ppo you dont need the referral. The Dr.s Office handled the whole insurance thing for me.
   — Rya M.

May 5, 2003
Check your 'coverage' I had BCBS - I made my 'own' appoitnment with the WLS - my PCP was never involved - it wasnt required by my insurance company.
   — star .

May 5, 2003
My insurance company did not require a referral from my PCP. My surgeon, however, did require a letter from my PCP so that he (the surgeon) was assured that the PCP knew what was going on so he (the PCP) could follow up with me after surgery as I lost weight. My PCP is the one who decreased and discontinued my meds for blood pressure, lowered my thyroid medication, and the like, based on labs he ordered. I have seen my PCP more after surgery than my surgeon. You really should have a PCP, no matter what your age or health status, regardless of whether or not you need a referral for a specialist or surgeon.
   — koogy

May 5, 2003
I think most insurance companies require a referrel to the surgeon from the PCP mainly because they want to ensure people are having this surgery because of medical reasons and not cosmetic. The surgeon will most likely require that your PCP do some tests before coming to see them.
   — Renee B.

May 5, 2003
I am in Indiana with BCBS PPO -And the insurance company had to have a letter from my PCP to support my diet history. If you get turned down the first time don't panic. They were very easy to deal with.
   — Autumn

May 5, 2003
I did'nt need any kind of referral from my PcP neither did my friend. Our PcP's don't even know at this point that we for sure had the surgery unless they sent them a discharge sheet from the surgeons. My ins. was UHC and hers was medicare. I think it is only that some ins. and some surgeons require a referral but obviously not all do.
   — Delores S.

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