I know - I know

ok - I know you all are probably sick of me asking /complaing - but there I go again - As with my inital bypass surgery - when it came to the letter of mecal necessity - I found a template on here and filled in my info and all my pcp did was sign - here is my question - shouldn't this time around just be a letter of clearance? Shouldn't the letter of necessity be written by my initial surgeon? who by the way sent me to get all of the work up done for the revision -  I mean so far I have a letter written - is anyone willing to read it and help me with it please - Jo

Hello feel free to send it to me and I will read it.  I appealed my first surgery in 2002 and won.  Yes, your surgeon should do a letter and also your pcp.  The pcp let's the surgeon know it is a medical necessity.  The surgeon then gives his.  Total letters 2.

thank you I am just going crazy - I will send it now

I found someting to help make your day !!! Straight from the Aetna website >>>>>> check this webpage  http://www.aetna.com/cpb/cpb_menu.html under CBP's  search Gastroplasty.

1. Repeat Bariatric Surgery:
2. Aetna considers medically necessary surgery to correct complications from bariatric surgery, such as obstruction or stricture.
3. Aetna considers repeat bariatric surgery medically necessary for members whose initial bariatric surgery was medically necessary (i.e., who met medical necessity criteria for their initial bariatric surgery), and who meet either of the following medical necessity criteria:
4. Conversion to a RYGB or BPD/DS may be considered medically necessary for members who have not had adequate success (defined as loss of more than 50 percent of excess body weight) two years following the primary bariatric surgery procedure and the member has been compliant with a prescribed nutrition and exercise program following the procedure; or

5. Revision of a primary bariatric surgery procedure that has failed due to dilation of the gastric pouch is considered medically necessary if the primary procedure was successful in inducing weight loss prior to the pouch dilation, and the member has been compliant with a prescribed nutrition and exercise program following the procedure.

6. Experimental and

Thank you so much -I am going to print it and also include it with the letter - thank you so much - to both of you God bless you for your kind acts - big hugs Jo