Question:
Can anybody please please please with sugar on top tell me what to tell my PCP.......
Tomorrow I am going to take the next big step to my long painful journey to WLS! I have an appointment with my PCP tomorrow and I am going to ask him to write me a letter of medical necessity. I have no idea what this is supposed to be like what it should contain. And I really want something that will give the insurance company no choice but to approve me! My PCP has never dealt with anyone who's had WLS but he supports me a hundred percent and says that he'll do anything to help me. Does anyone have a sample? And also, should I write my own letter? A letter about my miserable life as a super MO woman. I am so scared and nervous. Nothing ever goes my way. I thought by now I would have my insurance and still I don't! I had to cancel my LONG awaited consultation because the insurance hasn't become active yet. I would so much appreciate help with this. And I also want to say thank you guys...all of you for being here for me and all the enormous amount of support I got when I posted here and in my e-mail when I was feeling down in the dumps. I know it sounds corny but I love you guys!!! :o) I don't know what I'd do if I didn't have my AMOS family!!!!! God Bless!!! Hope to hear from someone soon! :o) — Samar M. (posted on June 25, 2002)
June 24, 2002
Have your doctor write about your co-morbits..High blood pressure..pain in
joints..sleep apnea..anything like that..the more, the better. Yes, write a
letter yourself describing the limitations that being MO has put on you
lifestyle...Just be honest and state the facts...Best wishes on your
journey
— Patricia R.
June 24, 2002
It is very important that your pcp lists your co-morbid health conditions.
It may also help if he lists your previous supervised dieting attempts.
Most importantly...he needs to write that your health is deteriorating
because of the morbid obesity and that having WLS can dramatically improve
your health conditions.
— Jennifer E.
June 25, 2002
Check my profile. I wrote a letter that you are welcome to copy. Plus there
is an appeal letter.
— Amy G.
June 25, 2002
I actually composed a letter to my PCP (1 pg single spaced) giving him a
brief summary of my life, what obesity has done to me, etc. He read it
while I was sitting next to him in the exam room. I just didn't want to
forget anything and when I get nervous I blank out. He asked me several
questions and decided to write a letter. His letter was 2 1/2 pages long
and very well written. Good Luck!
— TP
June 25, 2002
I think a lot of people make the mistake of writing long, emotional letters
to the insurance company. Insurance companies have very firm guidelines.
You either fit their profile for surgery or you don't. A lot depends on
your BMI, co-morbidities, failed diet attempts, general health, etc. Your
PCP is much more qualified than you think to write a letter on your behalf.
I would let him have a go at it himself and only step in if you receive a
denial and have to appeal.
— Terissa R.
June 25, 2002
I have the letter my PCP wrote to ins. on my profile. :-)
Maria
— Maria S.
June 27, 2002
Hi. I agree with the other responses to your question but want to share my
"technique" too... I wrote a letter myself (typed, very
professional looking) stating the following:
Statement of Medical Necessity for Bariatric Surgery
To Whom It May Concern:
_______(Name) is a patient of mine/has been a patient of mine since ______.
(Name)is morbidly obese and has been morbidly obese for as long as I have
known her. Her obesity contributes to several co-morbities and her overall
health is severly compromised by her weight.
I have seen the results of (Name)'s most recent CBC which indicates
severely elevated levels of blood glucose, cholesterol and triglycerides,
which directly contribute to diabetes and heart disease.
I feel that it is critical that (Name) lose significant weight as soon as
possible and that bariatric surgery is medically necessary.
Additional comments/Observations
Signature___________________,M.D. Date:____________
I took or mailed a copy of this letter, along with the results of my most
recent blood tests, to my OB/GYN, my dermatologist, my PCP and a surgeon
who had performed my hysterectomy several years ago. All of the docs
signed- some added illegible comments, and Bc/BS of FL/PPO approved my
RNY-Distal/open! I also wrote a one-page letter of my personal need for
WLS focusing on ill health, family history, social and psychological
effects of MO, etc...
I hope that this helps you! Good luck!!
— Rebecca T.
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