Sample letter of necessity

I'm trying to find out exactly what a letter of necessity should look like.  Does anyone have a sample?  I know my doctor will do his own but he wasn't even sure what my insurance required. Any help would be greatly appreciated!

i also think that is a great idea, I really dont think mine know what all to put into his either.

  Here is a basic sample of a letter that I found on-line somewhere, but cant remember.  I changed a bit to suit my needs, but you can get the jist of the letter...I hope!! :)   ON PROFESSIONAL LETTERHEAD    (Date) RE: Mary W  D.O.B. Dear Sir/Madaam Mrs. Mary W is a patient of mine. The patient is 5'9" and weighs ______ with a BMI of ____. The patient has been excessively overweight for most of her life and having attempted and been unsuccessful at many different methods of weight loss, would certainly benefit from Bariatric surgery. (Insert weight loss methods here) In addition to morbid obesity, the patient is suffering from the following co-morbid conditions: (e.g. diabetes, hypertension, obstructive sleep apnea, hypercholesterolemia, hyperlipidemia, ASHD, urinary incontinence, degenerative joint disease, osteoarthritis, PVD, shortness of breath, etc.) Mrs. W is currently taking the following medication________ for the treatment of________.   The patient is limited, due to her co-morbidities, in the ability to exercise but has tried, and is unsuccessful, as she is unable to walk more than one city block, and unable to climb a flight of stairs, without experiencing pain in her lower back, associated with bulging disks, pain in her hips and knees and exertional dyspnea. Family medical history is positive for Obesity, hypertension, diabetes, hypercholesterolemia, cva, and heart disease. I feel that my patient would benefit greatly from bariatric surgery as a tool to help lose the excess weight, lessen the co-morbidities and regain a more healthful life. Sincerely,

THANKS!