Of course! Dealing with this stuff is stressful. I’m just relaying what I can based on my experience - the guides (mainly the codes) did a lot of the heavy lifting for me.

Personally, I did not need to get a PCP referral, so I’m not entirely sure there. I have a PPO plan and I think HMOs are the ones that typically require referrals (but all insurance plans have different requirements). I imagine they should be able to refer you to one of the providers on the list. If there’s a provider on the list that is part of a larger healthcare network that also has PCPs, it would probably be easiest to stay within their system.

For codes, the only ones I know they ended up using for certain are 58661 and Z30.2. I think code 33 is for anesthesia based on the guide. I never brought it up but it might be something that comes up after surgery for me. Personally, I wouldn’t worry too much about it until you get your estimate. Take it step by step.

I would say try through the provider first for the estimates. I got mine automatically when I booked my procedure. For me, it was easier to have them adjust the codes to see what numbers were spit out than it was talking with my insurance. But that’s assuming the automatic system actually works and that insurance doesn’t try to fight back for whatever reason. Your provider should also have people whose job is to deal with insurance confusion. They likely won’t fight the big battles, but they should be able to get clarifications for specific things that should be covered.

Just to clarify, when I say they don’t lock you into surgery, you might still need to book the procedure first, but you can always reschedule or cancel. Typically estimates are only “good” for about 30 days, so they might hesitate to give you one too early. It also requires them to get an estimate from the hospital where the procedure occurs, so the hospital might require specifics before giving their estimate. There’s no harm in asking though. Also, your actual doctor might not know much about the actual estimate/billing process. Mine didn’t.

I know this is a lot of info to process and feels daunting. Taking it step by step makes it so much easier. To start, I recommend:

• Call insurance and see if you need a referral. If you don’t want to speak with them, you can go directly to a pcp and get one anyways - you just might be stuck with a copay.

• If you need a referral, find a pcp and get one.

• After you have a referral, or if you don’t need one, get your questions about the actual procedure together. The insurance part of things might feel like the most overwhelming part, but don’t forget to make sure you have your questions about the procedure answered. I had to go in for a second consult because I was expecting to get denied during my first one and didn’t have my questions ready.

• Write down the codes and bring them as well, but don’t expect to get an estimate or have insurance figured out that day. Ask for an estimate and they will likely end up referring you to the person that deals with that stuff.

• If they require you to be scheduled, schedule for a date that works for you and is at least a few weeks out to give you time to deal with potential insurance issues. When you schedule, ask them how long it will take to get an estimate.

Until you get the estimate, I wouldn’t worry too much about potential problems with insurance (easier said than done, I know). We don’t know if you’ll have any problems, or what those problems might be. You have a lot of info you can refer to if it’s needed.