Letter of recommendation from PCP

I know Dr. F. has a sample letter he uses for PCPs, but I do not really have co-morbidity's (unless you count Asthma, Depression, Headaches/Migraines and joint pain). I want to make sure I am approved in my first attempt, I have United Healthcare EPO Plus and they have yet to reject anyone. Thus, being the neurotic, pessimistic person that I am by nature, I assume the worst and hope for the best. I wanted to write my own letter, and have my doctor sign it.... Does anyone have successful examples? Or even better, are there any people with UHC who have samples or examples of what their PCP wrote? Thanks, Rebecca

Rebecca, I have UHC PPO and I didn't even need a letter from my PCP for approval. Dr. F needs it for your file He should have given you a sample letter in your packet. ~Jenn

Hi Rebecca, Yes everything you listed I do believe is considered co-morbdiity's. I have UHC Select EPO and I did not require a letter from my pcp. My surgeon Dr. Fabito from St. Louis Mo wrote my letter to UHC. I called UHC and they told me that it was not necessary to send any paperwork in that coverage was available from UHC. Let me tell you what that was a serious nightmare because New Start the company I am going thru has to have things done a certain way and they require something in writing. UHC received all of my papers on April 30, 2004. They told me it could take up to 45 days to get a response while it went through pre-approval. 45 days turned into 90 days and when the paper came from UHC it stated that coverage was available, but it was not a guarantee of payment. I received that letter the same day I had my initial consultation it was in my mailbox when I got home and when I read it I just wanted to cry because I was sure that wasn't what they wanted, but it was. And to make a long story short when you call UHC you will talk to one of two very distinct people-the extremely nice helpful person or satan. My suggestion to you is everytime you call them write it down-when you called, who you talked to, and what they said. In hindsight I didn't start recording everything until I was about 2 1/2 months into the waiting. So GOOD LUCK in only getting the extremly nice helpful person and satan can go back to where he came from. Sorry for all of the rambling I hope that it helps you out!! Denna

Thank you both for the information and tips. I guess I should just relax and let it happen, but I am just so excited! Rebecca

co-morbidities usually with insurance companies need to be LIFE THREATENING conditions, like sleep apnea, high blood pressure, diabetes to name a few. Joint pain, depression, migraines are not considered life threatening, just keep that in mind so you are not disappointed if you are turned down by your insurance. And remember just because you have a life threatening co-morbid it does not mean that the insurance company will cover the surgery. My husband had sleep apnea real bad (diagnosed and put on a c-pap) and high blood pressure and was denied the surgery by Cigna. Good luck.

Christine - I have the same problem as your husband. I have Cigna also and was denied. They claim that I didn't have the 6 months of physician weight loss management. I am getting ready to start the appeal process (if anyone has a sample appeal letter please let me know). In the letter they stated that my blood pressure and other ailments can be brought down by losing 10% of my body weight. I am going to put into the letter that losing the 10% isn't really the problem, I can loose that. My problem is keeping it off. That is why I want to have the surgery. Losing all the weight quickly is a perk to me. Any ideas from anyone would be greatly appreciated.

Hey, just looking back at other replies and did a quick search and thought you might want to see for yourself- *goto main entrance *goto search and enter co-morbidities *on the next screen run your search through WLS Library *and you can see what the co-morbidities the doctors use (usually good enough for insurance companies) I really don't have any "life threatening" co-morbidities BUT I was approved anyway (stress urinary incontinance, joint-pain, edema, GERD, and I'm just basically FAT) Just my opinion! Denna

Deanna: You just had surgery two days ago and already posting??? Way to go. I hope everything is fine. Joy

Thank's to everyone for posting great replies. I know I am just being neurotic when i originally posted. I just wanted to ensure I have a solid PCP letter. I have found out it is not required, but it is a good thing to have. Like previously stated, my insurance plan, which was designed by the hospital I plan to have the surgery at (not to mention, I work for),has not rejected one of the claims yet. I have contacted some fellow employees whom have had the surgery, and they said they received their approvals in record time. Many of these people did not have co-morbidity's nor super high BMI's. I guess I need to just stop being pessimistic and just get ready for the surgery! TTFN, Rebecca

With UHC you still need to check all your bills and etc. They are so slow in paying...It took them one year to pay my surgeon all over a stupid asst surgeon code that was wrong....Also they do not pay the difference between a private room and semi-private. My RNY CLinic puts you in a private room and you have no say so on it. I appealed and was denied twice. Also I just got a bill from the ultrasound for my gallbladder that ws done on 7-3 and it just now got paid with a $40.00 balance. GEEESHH I am glad they are easy approvals for the surgery but make sure you document everything you speak about with them on the phone. Date time who you talked to Etc...it helps alot when you have to followup on the same problem....I know this is the least of your worries what with getting ready for surgery...but just thought I'd give you some tips.. Ramona