Help with Letter to insurance company

LeslieWesleysyxx
on 7/19/16 3:30 pm
Revision on 03/14/18

Hello Everyone,

First off I am new here and have 1 week left in my 6 month doctor aided diet. I was informed by my surgeons office this week that I have to write a letter to my insurance company explaining why I feel I need gastric Bypass. Has anyone else on here had to do that? DO you have any tips or examples? I want to make sure I do it correctly. Thanks for your time and help! I hope to be more active in this forum since I found it a few days ago. 

Kudzu
on 7/19/16 3:44 pm
VSG on 07/28/16

I didn't have to do this, but every doc, nut, psych visit I have had over the past several months, I've been asked this question. For me, I feel that my years of yo-yo dieting has gotten me at the place where I feel this is my  best option. I've lost a thousand pounds over the years and spent a crazy amount of money with programs like Weigh****chers, Jenny Craig, Nutri System, Adkins and so on and so on. With every loss, I gained it back plus more. I need this tool to help me fight this never-ending battle and through this, I finally feel I can slay this monster. Just write to them your story. Good luck. 

White Dove
on 7/19/16 8:42 pm - Warren, OH

Real life begins where your comfort zone ends

mschwab
on 7/19/16 8:54 pm
RNY on 11/21/14

The best thing to do is call your insurance company and ask for a copy of the medical necessity coverage criteria for bariatric surgery.  Use that to craft your letter, and address point by point why you meet the criteria.  Be specific.  Remember your insurance coverage is a contract, and you need to show how you meet the terms of the contract.  PM me if you want me to review the letter.  I've worked in the industry for 20 years, so I'm pretty experienced n this stuff.

 Height: 5'7".  HW: 299, Program starting weight: 290, SW: 238, CW 138 - 12 pounds under goal!  

     

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