Question:
My PCP is giving me a hard time with my letter of
necessity. I've asked my surgeon to help... with this issue sinve all of my pre-op testing is done and the only thing I need is my primary Dr letter of necessity and the documented 6 month diets I've completed with him...My Doctor has lost his mind he told me we needed to do the 6 month diet again. I really dont understand why he is saying this. What else can I possibly do and say to get my letter of necessity in order for me to submit my paperwork for approval and get surgery date...anyone please help...sorry didnt mean to be so wordy — Jan D. (posted on March 26, 2008)
March 26, 2008
FIRST YOU NEED TO FIND OUT WHY YOUR DOCTOR WANTS TO RE-DUE THE 6 MONTH.
MOST INSURANCES WANT 6 MONTH OF WEIGHT LOSS MANAGMENT. THEN THEY WANT
VITALS AND THAT MEANS ALL THEN SOME LIKE MINE WANTED ME TO TRY FRA
DRUGS/DIET PILLS FOR AT LEAST 3 MONTH OUT OF THE 6. i HAD CIGNA WHO DO YOU
HAVE? MAYBE YOUR DOCTOR DID NOT FOLLOW ALL THE GUIDE LINES AND SO HE WANTS
YOU TO REDUE. I WOULD ASK WHY AND TELL HIM/HER YOU ARE NOT DOING THE 6
MONTH OVER. I HOPE I HELPED GOOD LUCK.
— aluvzu2
March 26, 2008
Angela I have HealthFirst and there requirements are 6 months documented
diets if BMI is lower that 40 then co-morb. are also needed. My surgeon
provided My PCP with the forms needed for the 6 month diet and all my Dr
needed to do is check off what we have discussed for that month, Eating,
Nutrituion, Ect, and write down my weight. Since My original Dr relocated
I needed to restart the diet because My origunal Dr went on vacation and my
monthly check up/Diet dates became inconsistent.I had to start mdway in
order for my visits to be consecutive.Therefore I re-started back in
October and started seeing my new Dr in November.My chart is in order and I
didnt go to a different clinic. I explained to my Dr back in Nov, Why I was
seeing My old Dr. He responded with "it's not a problem we need to put
your chart in order and continue from where your old PCP left off. Now the
letter of necessity is a crucial part of the approval proccess and I think
my Dr really lost his mind when he told me we needed to start over....All
he has to do is check my medical record everything is there........And by
the way yes you did help me....I just wanted to clarify my situation a bit
more.....thanks Angela
— Jan D.
March 26, 2008
Here is my suggestion, GET A NEW PCP!!!!!! His behavior stinks, ask around
and interview a few PCP and see if they will help you out, remember that
your new doctor will request you medical records from your all doctor, so
the new one will have your 6 month diet history then. Call a few and ask
them this first before changing. It amazes me how many doctors are still
against weight lose surgery, I work in the medical field and cannot tell
you how many doctors have asked me questions and said I should be a poster
child for weight loss surgery, no problems. I am not a poster child, just
like most other people who do well, I do not feel they know what a great
operation this is, all they hear is the horror stories, and then tell you
that you can do without the surgery, so not true. Do you think that even if
you did do another 6 months your doctor would give you the green light or
do you think deep down that he will say, look how good you did with the
diet, you don't need the operation! I personally would look around for a
new doc and take my records with me. Good luck to you and drop me a line
and let me know how you make out, take care!
Diane
— noboat4u
March 26, 2008
I would ask my PCP why the last 6 months did not satisify the requirement
and if you don't like what he has to say and he will not cooperate with
you, then find another PCP. Once the new one has your records he can help
you meet the requirements. Let him know that you are concerend about you
weight and have been working toward WLS solution, but your previous PCP had
let you down. He knows why you are there then.
— William (Bill) wmil
March 27, 2008
write to me...I have an excellent letter that you can use as a template,
your Dr. merely has to fill in the blanks apply to his letter head, and add
his license #. it has helped many!
[email protected]
— dessary316
March 27, 2008
I hate you are going thru this situation. I agree, get a new pcp. Also if
you seek out another pcp, make sure you have copies of all of visits with
the specialists. This will make your transition a lot easier. My sister
who had the band in 1/08-post op 50 pounds, switched pcp, and supplied
copies of her paperwork and she got her apporval and surgery date quick. I
hate you have to have a 6 month diet. I am scheduled for my band on
4/29/08, my insurance is bc/bs of illinois, and I was not required to do a
6 month diet. Hope this helps!
— savoy7658
March 27, 2008
Before your next appointment with your Dr. get a copy of your medical
records then approach him again and tell him you have already done the 6
month diet and ask again for a letter of necessity. Do you have any
comorbids? Sleep Apnea, High Blood Pressure, High Closestrol, etc? Have
you been tested? I was very lucky,,,well in a way I have those Comorbids
and was able to convince my doctor to write a letter stating what she is
treating me for and I included my records. It took a little bit but I was
finally approved. I have BCBS of Mi. Hope this helps. Good Luck!
— michelle66
March 27, 2008
My bmi is above 40 so i dont need to have co morb, however I suffer from
Gerd. arthritus, problems walking because my legs and feet are always
extremly swollen, and I have joint problems among a few other things like
loosing my breath ect. As far as high blood pressure no I was told that
from time to time I have low blood pressure no diebitis and no sleep abnea,
But this runs in my Family and I am at high risk of developing these co
morb. Besides the other issues I have I look at this WLS as a Preventive
tool in order for me not to develop diebitis,high colestherol ect....Thank
You all for responding ...You guys have been a good help....I have an appt
with my Dr on Monday and I'll try to speak to hin again I will demand a
copy of my medical record and if this gets any worse then I'll definetly
change my Dr.
— Jan D.
March 30, 2008
mose ins require sizx month weigh in and diet but he should have taken care
fof that already and you might need to get a second opinion.
— JULIAP
April 13, 2008
HI, THE FIRST TIME I SEND MY PAPER WORK IN THEY STATED THAT IT WAS NOT
CONSISTENT, A MONTH HERE AND THERE. I WAS TOLD TO DO A 6 MONTHS DIET PLAN
WITH MY DOCTOR. NOW I HAVE A NEW INSURANCE POLICY, SO NOW I AM JUST
WAITING FOR THEIR APPROVAL. MAKE SURE WHEN YOU GO FOR YOUR VISITS THAT THE
DR. IS DOCUMENTING THE CHARTS EACH TIME YOU VISIT. ASK TO LOOK AT YOUR
CHART BEFORE HE LEAVES THE ROOM.
— SHIRLEY43
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