ANY??? SUGGESTIONS??????????????

Today I went and saw my PCP. for my final follow up appointment before insurance approval.  One of the things that I have to get from him for the insurance company is a letter recommending surgery as a means to gain control of my obesity. (I’m sure you all under stand). Anyway, when I asked him for the letter, his response was, “Write one, I will go over it have it typed up a sign it.” Because he doesn’t have time to write such letters.

WHAT???????????????????????????????????????????

Now I have called my surgeons office and told them what he wanted me to do and asked if this was okay.  They said “NOT REALLY” but, they have had people in the same situation and it worked out just fine………..

     Now I guess that should have been enough. But, I don’t know what to say… How do I go about this?? Do I write a letter from him or do I write a letter from me and just ask him to endorse it? I don’t know anything about writing a DOCTORS recommendation. Isn’t that kind of dishonest????

     Has anyone had to do this for their approval???? How did you go about it.. I’m really open to suggestions. I just don’t know where to begin.

THE BIG PROBLEM IS I NEED TO DO IT  NOW!!!!!!!!!!!!!!!!!!!!! MY PAPER WORK WAS SUPPOSED TO GO IN TOMORROW. THEY ARE WAITING FOR THIS...

This is what my PCP wrote,


To whom it may concern,__________ ___________ has been seeing me for medical weight management. Although some weight loss was achieved, she has failed to achieve a significant amount despite activity and dietary changes.

Based on her history of ( insert your own co-morbidity's ) Bariatric surgery could be beneficial. There are no conditions that would preclude her from surgery.




My insurance accepted this and my procedure was approved. I found out today.

Good luck to you

Maria

I copied this from the OH site: 

If your bariatric surgeon recommends weight loss surgery, he or she will prepare a letter to obtain pre-authorization from your insurance company. The goal of this letter is to establish the "medical necessity" of weight loss surgery and gain approval for the procedure. The following information is generally included in the pre-authorization letter:
 

 Your height, weight and Body Mass Index and any documentation you might have as to how long you have been overweight.

Simply describing your condition as "morbid obesity" is not enough. A full description of all your obesity-related health conditions, including records of treatment, a history of medications taken and documentation of the effects these conditions have had on your everyday life is necessary.

A detailed description of the limitations your excess weight places on your daily activities, such as walking, tying shoes, or maintaining personal hygiene.

A detailed history of the results of your dieting efforts, including medically and non-medically supervised programs, medical records and records kept of payments to and meetings attended with commercial weight loss programs.

A history of exercise programs, including receipts for memberships in health clubs.

Ask your doctor to include information from medical journals regarding the effectiveness of weight loss surgery, particularly information showing the control or elimination of obesity-related health conditions.

Thirty days is the standard time for an insurance provider to respond to your request. You should initiate a follow-up if you have not heard from your insurance company about insurance for bariatric surgery in that time.

Thank you both.. I just find it really bazaar that this seams to be a normal practice. You're help is GREATLY appreciated.

Here is a link to another sample letter:  http://www.obesitysurgeryla.com/images/pdf/referral.pdf

I would change the first sentence though - it doesn't sound definite enough.


And yes, your doctor is not doing his job.   I've been asked to draft letters of recommendation for myself, my friend has to send her agent lists of places to try to sell her work ... I guess people do what they can get away with.  Maybe you can change doctors once you get the surgery over with.  Vote with your feet.

Good luck!

Alison

Oh I knew the ladies would give me one that I liked.. I have an OBGYN that lives next door and she has agreed to help me write one this weekend. I yours so I might just copy it. I think my PCP would be okay with that one. He doesnt want to write it but wouldnt you know it he has something to say about it. GO FIGURE!!!!!!!!!!

Trust me darlin'. If the good doctor had said he would write your letter, it would actually have been given to someone in the doctor's office. They would have read over your record to fill in a form letter just like the gals here gave you. Nurses, medical assistants, and medical records technicians aren't 'physician extenders' for nothing. I don't know of any modern doctor who would actually make the time to do it themselves. Even if he 'did it himself' it would probably be a dictation service which typed it out for him.

My doctor laughed when I took her my FMLA paperwork all filled out and ready to sign. What could I say. I'm a nurse.