Letter of Medical Necessity - samples needed!

My PCP asked me to write the letter for them to sign. I really really could use some samples!  Can anyone who's been successful help??

Thanks in advance!

Sheri

That's shocking really.  That's your doctor's job. 
Sorry I don't have one, but what they've asked you to do is unreasonable.

 Well, I didn't think it was an unreasonable request, as I pretty much had already planned to do it anyhow.   Heaven knows, I've written my own (work) performance reviews for decades.  If you want something done right... ya gotta do it yourself!!  And, to be honest, I probably know more about what the insurance company wants to hear than my PCP does.

:)

YMMV!

I totally agree with you!!  I also wrote my own letters for my PCP to sign.  She loved the fact that it saved her time and was specific to MY insurnace requirements.

I'll PM you the letter I wrote and had my PCP sign.

Nan

I couldn't PM you so here is a sample referral letter.  I also have sample appeal letters from myslef and my PCP fi you need them.  Myself, my daughter, and a friend of mine were all denied at first, but I wrote letters and appealed and alo three of us have now had surgery!!

Good luck to you!
Nan


January 01, 2009  
RE:     Patient’s name
DOB:   

To Whom It May Concern:  

This letter is in support of bariatric surgery for xxxxx xxxxxx.. She has had a life long struggle with obesity and has attempted numerous methods of weight management without lasting results for over xx years that she has been a patient with us. She has tried various weight loss methods, including Weigh****chers, Atkins, Richards Simmons, Liquid Protein shakes, Adipex, Slim Fast, Diet Center, Protein Power and the 6-Week Body Makeover. She has lost significant amounts of weight on some of these programs, only to gain it back each time. She has exercised in the past, including exercise tapes, walking on a treadmill, and following a cardio and strength training program. She has a strong family history of obesity, hypertension, Type II diabetes, and heart disease. At this time, xxxx is extremely committed to pursuing bariatric surgery.   xxxxxx has been diagnosed with morbid obesity, along with co-morbidities of Osteoarthritis of the knees and Hypertension. 

Her current weight is xxx pounds and height of x’x". Her BMI is xx. In the past couple of years her weight has fluctuated between xxx and xxx pounds in our office.     I believe that xxxxxxx is extremely motivated and knowledgeable about bariatric surgery and committed to making this a lifelong change. Her ideal body weight and weight loss goal is approximately xxx pounds. She is currently taking no medications and has no known drug allergies.  

xxxxxx began a 3 month multidisciplinary surgical preparatory regimen on xxxxx xx, 2008. She has been in compliance with all components of the program and at this time, I feel that she has exhausted all of the options available to her other than weight loss surgery. I find this surgery to be a medical necessity and have referred her to xxxxx xxxxxxxxx, M.D., who specializes in laparoscopic Roux-en-Y gastric bypass surgery and offers extensive pre and post operative follow-up care.    Should you have any questions regarding this recommendation, please feel free to contact me directly.  

Sincerely, 

Xxxxxxx   xxxxxxxxxxxxx, M.D.    
Address City, State, zip Phone#

 Wow Nan, what a great letter! Thanks so much for that! :)

Nan,
I just wanted to thank you from the bottom of my heart.  I have been dealing with insurance delays and finally a denial, with no clear explanation of what they needed.  I used your sample letter, put my information into it, took it to the doctor, he signed and faxed it to the insurance company and within 24 hours I had approval. 
Thank you so much.
Sue

You are so very welcome!!  I am happy you got your approval! 

Good luck to you!

Nan

Sheri,
I used Nan's sample and within 24 hours I had approval.  I tailored the letter to my medical information, took it to the doctor, he signed it and faxed to the insurance company. 

To Whom It May Concern:

 

This letter is in support of bariatric surgery for ___________.  She has had a life long struggle with obesity and has attempted numerous methods of weight management without lasting results for over six years that she has been a patient with us.  She has tried various weight loss methods, including Weigh****chers, Atkins, Liquid Protein shakes, GNC’s Release program, The South Beach Diet, Slim Fast, and the 6-week body makeover.  She has participated in exercise programs including two memberships with CURVES, the most recent membership started in January of 2009 and still participating.  ______has met several times with our dietician, and has followed recommendations for her meals.  She has lost weight in some of these programs only to regain the weight and more each time.  She has a strong family history of obesity, Type II diabetes, and heart disease.  At this time, _____is extremely committed to pursuing bariatric surgery.  ______ has been diagnosed with obesity, along with co-morbidities of Type II diabetes and acid reflux.

 

Her current weight is 235 pounds and height of 5’6".  Her BMI is 37.9.  In the past couple of years her weight has fluctuated between 216 and 235 pounds in our office.  I believe that _____ is extremely motivated and knowledgeable about bariatric surgery and committed to making this a lifelong change.  Her ideal body weight and weight loss goal is approximately 130 pounds.  She is currently taking several medications to manage her Type II diabetes, cholesterol levels, blood pressure, acid reflux and depression.   She has no known allergies.

 

I feel that ______ has exhausted all of the options available to her other than weight loss surgery.  I find this surgery to be a medical necessity and have referred her to ________, M.D., who specializes in laparoscopic Roux-en-Y gastric bypass surgery and offers extensive pre and post operative follow-up care.    

 

Should you have any questions regarding this recommendation, please feel free to contact me.

 

Sincerely,

I was just denied for LAP-BAND through CIGNA HEATHCARE, Monday August 16, 2010... I plan to use NAN's sample appeal letter too!!  My denial letter states the denial is from 09/01/2010 to 12/01/2010. Does that mean they wont even consider an approval until AFTER the denial period is over?