Almost there
I'm almost there.......just have one more visit to the general doctor for my last weigh in and he'll write my letter. Does anyone know or have a letter that I can show my GP with all the information that my GP has to write to my insurance company. I kinda remember seeing an example letter but for the life of me can't remember what site it was on.
This is the one on my Dr.'s site.
Please call if you need assistance. We appreciate your cooperation. Thank you.
30 North Union Road ● Suite 104 ● Williamsville ● New York 14221
(716) 565-3990 ● (800) 535-8236
www.SynergyBariatrics.com
13
Sample Letter of Medical Necessity
(Date)
Dear Dr. (your physician name):
I am referring (patient name) to you for consideration of gastric bypass surgery for severe obesity. The patient has been morbidly obese for (at least
five) years and has failed weight loss attempts while under my supervision. See the
attached page for the patient’s detailed weight loss history.
The patient’s history includes co-morbidities of (diabetes, hypertension, arthritis,
backache, sleep apnea, depression, etc. as applicable). There is no significant liver,
kidney, or gastrointestinal disease present; there is no treatable metabolic cause for
obesity such as adrenal or thyroid disorder. TSH levels were (normal, high, low) upon
testing. The patient uses (list all medications. NOTE: If patient is taking psychotropic
medications or has a psychiatric history, a pre-surgical psychological evaluation is
required). There is no history of alcohol or substance abuse.
The patient weighs ( ) pounds and measures ( ) in height. The remainder of the
physical examination is unremarkable (except for ________________________).
I believe the patient is a good candidate for surgery and would benefit from significant
weight loss. I would be happy to see the patient again prior to surgery for medical
clearance.
Sincerely,
(Primary Care Physician)
Wow. You are almost to the end of the wire!
I think that my Doc just had to send the progress notes of each visit that I had for the last 6 months prior to surgery. When I gave him a format for a letter, he said that he didn't need it.
Don't worry, I'll bet that your PCP has done this numerous times and will know how to handle it.
Good Luck Christine~~
Diane