Can anyone share their letter of medical necessity from their PCP?

Hey everyone,

So my PCP is very willing to write a letter of medical necessity for me.  But he has no clue where to start ot what to put in it so he asked for an example letter from the surgeon.  The surgeon said they can't do that.   I tried googling some example letters and I'm not finding any.  Is anyone willing to share a copy of theirs?  I'd really appreciate it.  

I already know the insurance company will approve my surgery I just need this last piece!

Thank you!

If you can, please email to [email protected]  I'll be forever thankful!!

Hi:
I don't have a sample but the letter is pretty straightforward like a referral. It should include the following:
-Your current weight.
-Your 'co-morbidity(ies)': conditions due to your weight or worsened by the excess weight, such as sleep apnea, diabetes, high blood pressure, etc.
-What you have attempted in an effort to lose the weight, which shows that you have been able to stick to a diet in the past and can do so once you have the surgery.
-A note of changes you have made in the pre-op period.
-That you are in good enough physical and emotional health to withstand the operation and to benefit from it.

I hope this helps!
Teresa

Haha yes I gave him the list of things needed and even the key words!  I think the office is being super lazy they specifically asked for an example letter.

I would bet you could write the letter yourself! Good luck!

You are talking about a letter of medical necessity for plastics right?

You want to document the diagnosis of the skin issues (in medical terms) you should get this from your doc.  You will also want to demonstrate the issue is on-going and resistent to less invasive treatment.  You will want to list the prescription medications you have tried and to what effect.  In short, you want the letter to say the excess skin is making you ill and the only way to cure that is to cut it off!

Red

Yeah as easy as this sounds the office is being crazy.  They want an example letter.  I would type it myself for the doc to sign even at this point!  They are being difficult.

This was posted awhile back by one of our active Plastic Surgeons on this board, Dr. LoMonaco.

I saved it just in case it would be helpful.

Copied and pasted.....


Just as an example, here is what we write:

-------------------------------------------------
Dear INS company,

Please find the records of Ms. Chelsea attached.  As you can see, she was seen December, January, and March by Dr. Smith for skin rashes and dermatitis of the ________ area(s). Each time, she was provided prescriptions for __________ which did not adequately control her skin problems (They already have a record of this BTW because they are paying for it).   Her skin problems have been recurrent in spite of the treatments she has bene given.

I propose to remove the excess skin of the ________ to permanently remedy her skin infections, which have not responded to the above medications in spite of several months of treatment.

I feel that surgery is the only available option that will result in a permanent correction of this patients skin conditions, which have nagatively affected her quality of life.
----------------------------------------------------

The plan language of nearly all the maor carriers asks for this quite specifically, so I advise patients seeking coverage to "do what the plans want" in order to get coverage. Often there is confusion over what the term "documentation" means, and that does not refer to a letter alone.  They want office visits, prescriptions, and any other proof that you went to the doc for your skin issues.

Hope this helps and good luck,

Dr. L.
 

Here is a link to the actual thread     http://www.obesityhelp.com/forums/plasticsurgery/3982173/Denied-once-trying-again/

Thank you thank you!!!  I wish there was  a search function on there...I would have found it too.