Question:
Can this be circumvented with a letter of urgent medical necessity?

If your PCP has told you that dieting is beyond fixing the weight problem and the current health problems are urgently life threatening, has anyone had the 6 mo. supervised diet requirement waived with a PCP letter?    — Sheila T. (posted on July 22, 2005)

July 22, 2005
Quite possibly but it is going to take a very detailed and strongly worded letter to accomplish it. The doc may have to submit tests or other documentation proving that waiting 6 months might be too late. You also then run the risk of them coming back saying you are too sick for surgery and won't approve it. If your doc feels strongly it needs to be done now, then go for the approval. Nothing to lose. I'd also start a supervised diet immediately rather than count on them waiving the requirement.
   — zoedogcbr

July 22, 2005
You'd have to be pretty darn sick, and as Chris said, they may then say you are too sick for surgery. The way I understand it is that unless you are in an immediate/impending life-or-death situation, that is the only way to get emergency treatment without insurance approval. I don't know that a PCP letter alone would accomplish this, you'd probably need documentation and records from any specialists treating you for your life-threatening illnesses, and it would also depend on what those conditions were. They wouldn't do this type of surgery on someone who (for instance) had uncontrolled diabetes, uncontrolled thyroid problems, COPD, uncontrolled sleep apnea, or any sort of uncontrolled liver, stomach or intestinal dysfunction. Who is your insurance company? Some companies have a multidisciplined 3-month program that you can do instead of the 6-month program. Good luck to you!
   — Shayna T.

July 24, 2005
I just finished my 6 month diet. ( I tried to get out of it. ) Ity is impossible. I thought it was going to be a lifetime. Time went by very fast. I know it is hard. I thought I wasnt going to make it myself. I only lost 4 pounds. I am now waiting on my approval. They told me that was all they needed. So I do not feel I will have a problem. Just keep busy and also try and keep your mind off the surgery. I got so bad that is all I talked about. It is all I lived. I missed out on alot the past 6 months. Just act like to did before you decided you wanted the surgery. Time will fly. Take Care Barb
   — barbie12

July 24, 2005
Every Insurancre company and PCP and Surgeon are different. You can't base answers rom someone else on your experience unless they have the same dr's and insurance. That being said...I was originally told I would have to do 6 months of nutrition counseling and diet before i could even see the surgeon. I wrote a letter to my insurance comapny and my PCP and sent them to hime to write a letter. In the letter I stated all my facts (YES FACTS) and my weight loss attemp history. I started the nutrional counseling like they rewuired and within 3 weeks I had my referral to the surgeon and 3 weeks later I had my approval and date for surgery. I have been told I was one of the lucky ones...I got the FAST TRACK! I am so happy now...I have lost 105 #'s in 6 months and have energy that I haven't had in years... Anyway - if you have anymore questions, email me...and Good Luck on your journey. ~L
   — Laura G.

Click Here to Return