Question:
What would be helpful for my PCP to write for the insurance approval?

My totally supportive PCP has asked for a sample letter or an idea about what wordingcan be included in a letter from him, that would be helpful in getting approval. Any help with this is much appreciated:) [email protected]    — Laurie B. (posted on October 24, 2001)

October 24, 2001
Hmm your PCP is writing the letter? Why isn't your surgeon? just curious. Your PCP can help supply your surgeon with documented medical history, for with most insurances, there must be a "medically necessary" before they will approve it. Some of the criteras are: being 100 pounds over your idea weight for your height and age. Having co-obesity related illnesses like: hypertension, asthma, gerd (gastric reflux) arthritis, diabetites, sleep atena, depression to name a few. (I know some people have gotten approved without any co-obesity related illness just being 100 pounds over their ideal weight range) but I gather each insurance company has their own requirements. I would suggest: 1) you contact your insurance company and find out what their requirements are, if there is an exclusion in their policy regarding this surgery. (exclusion meaning the policy that your employer has selected does not included gastr-bypass surgery under its coverage.) You want to arm yourself with any possible pitfalls before you submit the request. I feel that's one of the most important step most people over-look when they first consider this surgery by not taking the time to find out what their insurance's policy states about wls surgery. (to me it like putting the cart before the horse so to speak) 2) Your PCP can refer you to a surgeon and he doesnt need approval for that. Then your surgeon can help you with the information supplied from yourself and your pcp, to prepare an appropriate letter of pre-certification to your insurance company to see if you will be approved. **if you have an exclusion in your policy you can fight it but lets cross that bridge when and if you come to it.** That's just my thoughts I could be wrong.
   — Gwen M.