Need someone who has experience with WLS to help me?

I need help with making sure I have everything in line and ready for the next step.  I am starting my 3rd month with my PCP and my question is when do I need to see my surgeon, also I need help on getting my referral letter for my surgeon from my PCP ready, he said that if I would get it together, he would put it on letterhead and sign off on it.  I want to make sure it is a good one.  Any help from anyone would be greatly appreciated. Thanks

I think a lot of it depends on your insurance.  You might want to give them a call and ask what their procedures are for approval.   Do you have to get a referral letter from your PCP before finding a surgeon? You could call a couple surgeons in your area and ask how they generally work with your insurance company. Good luck, and keep us posted!

Hi Victoria,

It's nice to meet you! Welcome to the NC board. I hope that you will find this forum as warm and supportive a community as I have.

It sounds like you're getting things in place. Most programs take a few months to get through the 'process' so if you are 3 months into your 3 tto 6 month medically supervised weight loss program, it's probably a good time to contact your surgeon's office. They will be able to give you more details on the timelines for their program. You can also do a search on OH and on the internet in general re: WLS referral letter to get some more examples.

A Letter of Medical Necessity and weigh-loss history are necessary to obtain prior authorization for obesity surgery. A Letter of Medical Necessity states why significant weight loss is medically necessary for a patient and usually includes the following information:

• Patient's weight (which should be 100 pounds or more above ideal weight or a BMI more than 40 or more than 35 with associated medical problems to qualify)
• List of medical problems associated with obesity, such as type 2 diabetes, sleep apnea, hypertension, etc. Address co-morbid conditions (those that can shorten your life) first, and follow with quality of life issues (those that impact your life, such as chronic, dibilitating joint pain).
• Number of years patient has been overweight (which should be at least five or more)
• Number and types of failed weight-loss programs attempted in the past
• If you create a document or packet listing all your weight-loss attempts (self-controlled or medically supervised) and their results, you can substantially increase your chances of getting insurance coverage for the procedure. You should include any commercial diets or medical records of your weight-loss efforts.

Here are a few links to letters of medical necessity:

http://www.obesityhelp.com/content/letterofmedicalnecessity. html This is a form letter you can use as springboard to create your own.

http://www.geocities.com/Heartland/Woods/4485/appeal.html While this is an appeal letter, it provides a lot of information that might have helped in the first place. It is not written from the physician, it's from the patient. I included a patient letter with my package.

What you want here is to identify all of the reasons why you need the surgery and why you are a good candidate for the surgery.

I hope that this helps.

Barb