Doctor's letter of medical necessity

prettypixels
on 9/1/11 12:30 am
This is the last thing that I need to resubmit to insurance, but I'm not sure exactly what it is that it needs to say.

I saw this link, which says the doctor should write:
*A detailed description of the limitations your obesity places on your daily activities
*A detailed history of the results of your dieting efforts, including medically- and non-medically-supervised programs

http://www.dummies.com/how-to/content/seeking-insurance-approval-for-your-weight-loss-su.html

That seems like a lot to ask a doctor; I was going to write that stuff in a letter myself. Is this typically what is required? I was hoping she could just write something a little less time intensive. This doctor is new to me so I'm nervous. Actually I'd be nervous anyways especially after my last doctor experience!

Any tips would be so helpful. Thanks!!!
Banded in 2001 at 217 lbs - Band to DS revision 10/25/11 at 310 lbs
If life with your band sucks, you are not alone and it's not your fault.  Check out the failed lap band group!

    
Nicolle
on 9/1/11 2:25 am
I wrote the letter myself and my doc added some stuff to it and then put it on her letterhead for submission. If you PM me your email address, I can send mine to you.

Since you are a reviions, I would imagine it would be helpful to be able to talk about WHY your band failed and what you're living with now, too.

Nicolle

I had the kick-butt duodenal switch (DS)!

HW: 344 lbs      CW: 150 lbs

Type 2 diabetes and sleep apnea GONE!

(deactivated member)
on 9/1/11 2:58 am
First of all, laughing at the "craptastic" band.  Very cute!

Typically, that's what the insurer is looking for - a compelling medical need for you to have the surgery. 

Sometimes, a patient will write the history and limitations part and the physician will incorporate the info or use it as an addendum.

BUT the key is this - you've got to get over your fear of the doctor.  If you are going to have this surgery, you have to be prepared to go toe-to-toe with physicians at all levels - surgeons, PCPs, GIs, Hematologists - all of them.

So put on your big girl panties and ask for what you want!  :)


Lori F.
on 9/1/11 5:57 am - Chula Vista, CA
Make sure, also, that you are specific. My PCP wrote 1 paragraph- a list of my comorbidities- as my LOMN. Dammit! I should have just done it myself and asked her to sign it. She acted like she knew what needed to be done...but...GEEZ! A fourth grader could have written that! So, be very specific and give him/her an example if need be. Good luck.
Pre-band highest weight: 244
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW:
260 (yes, with the band!) 
Current Fill: 5cc in 10cc band
BMI: 49
prettypixels
on 9/1/11 8:20 am
Thanks everyone! It helps to hear that most people just wrote it themselves

I DO have my big girl panties on Lynmarie. I had a really awful experience with a doctor recently so I am definitely a bit gunshy, and I just want to make it as easy as possible for her to do it. I know this doctor wants to support me through this but she is new to me, kwim? It's so easy for them to just be like, seeya! I really like her and want to stick with her. I hate hate hate doctor shopping.

If you look through my old posts, I wrote a freakin' book about my crazy assed last doctor who I will never be returning to.
Band to DS
on 9/1/11 12:57 pm, edited 2/3/12 11:01 pm
Unfortunately, I had to delete this post due to privacy concerns.

Got a lap band in 2008. Tried hard, but didn't lose much weight & developed swallowing problems. Fought my insurance company for almost a year & finally had a band to DS revision on 5/11/12. Have now lost 125 pounds. Yay!

ThisIsMyUserName
on 9/2/11 9:01 am, edited 9/2/11 9:03 am
I'm Pre Op, but approved by insurance. I will be a virgin DS'er so Im not sure if Im stepping into territory that I know nothing about BUT...my PCP's nurse referred to it as something specific...like an H and P work up? Or something? She seemed very familiar with the request and used that term and although I needed a "special" appointment to get it, they didn't seem to treat the request as anything out of the ordinary. I went to the appointment and my PCP  asked me questions about stuff I hadn't answered since I became a patient (am I a smoker or drinker, any other health issues, number of pregnancies etc etc etc.) I waited about 15 minutes or so and he gave me this report. It was a very long and detailed report, something like 5 or 6 pages single spaced. I only skimmed it and can't seem to find it but it basically described my physical and mental state from head to toe literally. . It then tells of my history of obesity and the benefit I would get from the surgery of various conditions. Again, Im a virgin DS and I have no real comorbids but he did make sure to say I'm on the verge of gettting them.  I was approved. I say that to say don't be scared to ask for a long detailed letter, It took my doctor NO TIME. He had one still warm from the printer in my hands in less than a half hour. Its not like he had to take up hours of him time. Now, Im not sure how much was done beforehand or how much the nurse did while he was talking to me. Who cares, the letter was hot off the printer and in my anxious little hands in about 15 -20 minutes. I  know what it's like to be gunshy and all.  Definitely work on that,  but baby steps until then. Try faxing your request, or sending an email asking for what u need in writing.   I switched surgeons and that surgeons office does the LOMN themselves. I'm thinking as a revision your surgeon may be able to write a much better letter about the band neeing removing than a PCP.

Good Luck
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