Medical Necessity Letter - Page 2 - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

hummingbird5953 · 03-23-2007, 12:12 PM

Quote:

Originally Posted by bridgetgirl

If you weighed in that time period, and its documented in your chart.

No in-office weight in...that would have made too much sense!

Seriously, the pcp is older and pretty old-school and never suggested that I should come back for periodic weigh-ins. Wish I had thought about it!

Guess I'll just have to try to be patient while I wait for the surgeon's office to call and schedule my first in-office appointment and see what they say. I'm not good at "patient"!

JenBear7 · 03-23-2007, 07:54 PM

I just had to fax the requirements to my pcp too

My surgeons office said it doesnt have to be fancy. Just I have been Jen's doc for X amount of time. I am aware that she has tried x, x, and x diets for a combined total of x amount of time. And.. the surgery is medically necessary because of: x, x, and x.

I also faxed them a copy of my insurance weight loss surgery policy.. (well the first page with the things they need)..

I did not have to be on a medically supervised diet for 6 months. My insurance company does not require that. And trust me.. I have asked them.. more than once.

MiladyB · 03-23-2007, 08:49 PM

Here is a sample of a letter to show medical necessity:

(Physician Letterhead)
SAMPLE LETTER OF MEDICAL
NECESSITY
___________(Date)
RE: ________________(Patient Name)
I.D. # ___________
To Whom It May Concern:
Please accept this letter as a formal request for authorization for Roux-en-Y gastric bypass
surgery for my patient, ________________, ID#___________. He/She has been a patient of
mine since _______, has been morbidly obese for ____ years and has continually struggled to lose
weight. His/Her medical history indicates that she has tried many diets consecutively during the
past two (2) years under medical supervision, including, _________________for ____months;
______________for ____months, _______________ for ____months, ____________for
____months and low fat low calorie diets on and off since the age of _____. Although these
programs have initially shown promise, all ended in failure with little or no weight loss.
Mr./Ms. has been diagnosed with morbid obesity as well as _____________, ______________,
________________ and _______________. His/her co-morbid conditions are being treated with
________________________________________. His/her weight is ______ pounds, height
_____ with a BMI of _____.
I find this surgery to be a medical necessity and have referred Mr./Ms. ____________________
to Paul B. Wizman M.D., who specializes in laparoscopic Roux-en-Y gastric bypass surgery and
offers extensive pre and post-op education and follow-up care.
Should you have any questions regarding this recommendation, please feel free to contact me
directly.
Sincerely,
___________________, M.D.
__________________________________________________ ___________________________
2960 N. State Road 7, Suite 102, Margate, Florida 33063
954-969-1355 Fax 954-969-1232 www.DRWIZMAN.COM

tma · 03-23-2007, 08:51 PM

anyone with surgery at Stanford U who can share your experience with me? I am going thru with all the requirements, blood chemistry, nutrition evaluation, scheduled a psychiatric evaluation and all... but I am still a bit anxious and nervous about my decision.

MiladyB · 03-23-2007, 08:56 PM

Here is a link that also has another sample letter. I hope you find these helpful.

http://obesityhelp.com/content/lette...necessity.html

hummingbird5953 · 03-24-2007, 07:37 AM

Jen & Beth,
Thank you so very much for the info!!!!

I'm going to get started crafting a letter now, using your tips, so that I can take it w/ me to my first in-office appointment with the surgeon!

sweetchristiangal · 03-24-2007, 12:46 PM

when you get your letter or talk to them about it make sure they include everything:
depression if you have it? do you suffer from social anxiety due to your weight? Join pain, shortness of breath, irregular periods, blood pressure diabetes, anything and everything that can be remotely linked to MO. My PCP even put in that my weight causes ear infections because I have a round (ie fat) face. 120 lbs later I still get regular ear infections. I am actually considering tubes for them lol.

hummingbird5953 · 03-24-2007, 03:11 PM

Quote:

Originally Posted by sweetchristiangal

when you get your letter or talk to them about it make sure they include everything:
depression if you have it? do you suffer from social anxiety due to your weight? Join pain, shortness of breath, irregular periods, blood pressure diabetes, anything and everything that can be remotely linked to MO. My PCP even put in that my weight causes ear infections because I have a round (ie fat) face. 120 lbs later I still get regular ear infections. I am actually considering tubes for them lol.

Thanks for the info!!!