What Should I Include?

I'm taking a trip to my PCP's office on Monday to drop off my letter of medical necessity that I wrote on his behalf so that he can sign it. When I called his office on Wednesday saying that he needs to sign the letter and submit his notes/reports, a nurse returned my call saying that he will be out of the office until Monday. I want to make sure my PCP knows what needs to be faxed to my surgeon because I can't trust that the nurse will relay the message to him. Should I write a few notes on another piece of paper on what he needs to submit to the surgeon's office? He knows he needs to send his notes from each visit, but I'm wondering what he has written in those said notes. Would it be a good idea to lay out what should be written in those notes?

I don't want to seem annoying, but I don't want to get a denial from the insurance company because my PCP did not provide adequate information. Does anyone know what his or her PCP wrote in his or her notes? Was it just general stuff like "So and so has cut out fast food from his/her diet and increase his/her exercise from thirty minutes to an hour"? I also have six "progress reports" that my surgeon's office gave me so that my vitals (weight, blood pressure, etc.) are all documented. I know the insurance company wants proof from my PCP, but what are they exactly looking for? I feel like too much information is better than too little.

GAAAHHHHHHHH!!!!!!

To the best of my knowledge, my PCP had nothing to do with any part of my WLS... I never even mentioned to him that I was going to see my bariatric Doctor. Or course, I'm not that involved with my PCP, I don't get sick a lot, and only have to see him to get my refill for my thyroid meds... 

It would seem that the insurance person at your WLS doctor would know all the specifics about what the insurance company needs, and might be a good person to talk to about what the letter should say.

Good luck! Getting approved was the most frustrating thing for me!

I don't mean to be negative, but I doubt anyone here can give you a good answer. The best way to find out what your insurance requires is to ask them.  Can you get the complete coverage manual from your insurance or get it from their website? Even if the carrier is the same, coverage can vary depending on what riders may be attached. For example, I've had BCBS with two different employers. One was a Catholic hospital and nothing reproductive was covered. The other paid for abortions.

On the positive side, an initial denial may not be the end of it all. Most allow for appeals and resubmission.

I've looked at the policy, and all that it states is that I need to have a six-month medically supervised diet with a PCP or other designated licensed provider. All the policy says is that I need documentation from my PCP. I'm assuming this is why my surgeon's office supplied me with those "progress reports" so that the insurance can see my vitals from month to month.

Here's what my policy says:

"Documentation should include medical records of the physician's or the designated licensed provider's (as listed above) on-going assessments of the patient's progress throughout the course of the nutrition and exercise program. For patients who participate in a structured nutrition and exercise program, medical records documenting the patient's participation and progress must be available for review."

I had to have a 6 month medically supervised diet (in addition to other requirements documented by surgeons office).  My insurance company suggested that the PCP summarize the visits on one page (date, weight, discussion with patient).  The surgeons office included that summary plus a copy of the full medical notes from those visits with the submission.  It was approved.

My GP just copied his chart notes from my monthly check-ins.

If you're concerned, call your insurance company (use the phone number on the back of the card) and ask.

I had to have a letter from my PCP. I knew what it had to say so I wrote it and he printed it on his letterhead and signed it. I love my doctor 

I scheduled an office visit with my PCP and we wrote the letter together... Mine was basically for documentation of visits and weights. The Surgeon's office pulled some weights they had from visits and one from when I was in the Hospital that year for my colonoscopy. I obviously was not required to diet, just have documented 6 months of visits...

I did not need referral from PCP...so no medical necessity needed on their side... that was from surgeon's office.

I have BCBS PPO and they also required six-month medically supervised diet with a PCP or other designated licensed provider. The letter my doctor wrote was basically a history of weight loss medication I have taken over the years, seeing a nutritionist, and the many failed attempts at losing and maintaining weight loss. The insurance company just need some proof that you have made some attempts at losing weight prior to just having surgery. I called BCBS and asked was weight loss surgery covered under my health plan prior to even getting a letter from my doctor. My surgery date is scheduled for 6/27/16.