Question:
Please help with Letter of Medical Necessity
Please, some kind soul help - I'm using the model Letter of Medical Necessity on Obesityhelp.com., but need three questions answered: 1) The initial paragraph talks about personal BMI, and for me would go like this: I am 5 ft. 6 1/2 inches tall and I weigh 350 pounds. My body mass index is 56.5." It goes on to explain how a BMI is calculated, talks about the numbers that indicate mild, moderate, severe, and very severe obesity (BMI greater than 40). The final statement is "The annual number of deaths in America attributable to obesity has been estimated to be 300,000 deaths per year. With my abnormally high BMI, I am at an estimated ____percent increased rish of death at my present weight." I need the blank filled in. Obesityhelp.com is so wonderful and all-inclusive, I'm sure the way to calculate this is right in front of me, but I sure can't find it. Also, the model Letter refers to the Diagnosis Code for Gastric Bypass as 278.01, and the Prodcedure Code as being 43844. Is that for LAP, as well as open procedure, or are they two different Procedure Codes and Diagnosis Codes? And finally, do I need to specify a surgeon's name in my request to the insurance co., for approval. And, yes, I do have to do all this leg work myself; this approval business takes long enough, and I've heard too many horror stories about things being "lost, mis-faxed, not faxed at all, sitting on someone's desk for weeks," etc. When I finally submit my stuff, it may be in a bound book, so I can't hear any more excuses than many of us to, as it is, when parties are trying to deny individuals this surgery. — pam C. (posted on June 2, 2002)
June 2, 2002
My BMI is close to yours, at about 52 or so. My doctor said in my letter of
medical necessity that this would increase my risk of major illness and /
or death by 50%. Dunno if that is the right percentage, but it's the one my
doc used for my BMI. Hope this helps.
— Greg P.
December 14, 2002
I'm 5'10 and weigh 309, my BMI is 44.3, and according to my surgeon I'm at
an 80% increased risk for death. Hope this helps.
— Terri R.
August 7, 2003
I believe you figure out the percentage this way:
Use your current weight...mine is 255, then subtract your ideal weight from
that...mine is 134 (I got that from the obesityhelp.com section under
Calculating Your BMI. Click on "Looking for the weight loss
planner?", insert your weight and height and then use 100% for how
much excess weight you want to lose. It will tell you what your ideal
weight should be.)
So, subtracting my ideal weight from my current weight leaves me with 121
pounds. You will then divide your excess weight by your ideal weight.
Mine would be 121 divided by 134, giving me a total of 0.9029. Move the
decimal over 2 and that gives you your percentage. Mine is 90%.
OK, Math people...if this is wrong, please correct me!
— Cheryl K.
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