Question:
Who writes Letter of Medical Necessity, plastic surgeon or PCP?

I am having a hernia repair in November and would like to get a tt at the same time. Who would write the letter to my insurance co? I have made complaints about my back pain to my PCP, he doesn't have a clue that it would be related to my belly. He knows I want a tt and suggested that I wait until I heal from the hernia repair! I have not had any rashes. My RNY surgeon says the PCP has to write the letter. How do I approach him? HELP Please!    — Janet R. (posted on August 14, 2002)

August 14, 2002
Tell the PCP it makes sense to have the tt done at the same time as the hernia repair so you only have to undergo one surgery rather then two. Tel him your going to have the tt done anyway so you would appreciate any help he could give by writing a letter of medical nexcessity documenting the back pain and any other problems you have with the excess skin. Send pictures in with the letter of medical necessity too of your stomach. I would ask for the letter from the PCP so I could personally send it in to the insurance company (some doctors claim they sent the letter and they don't). Then add your own personal letter to his letter and explain any limitations and problems you have due to the excess skin on your stomach due to the excessive weight loss. Insurance companies do read these and make decisions based on those letters and pictures. Show your stomach in the worst possible way so the insurance company has more sympathy to possibly pay for it. Also, explain your trying to save the insurance company money by having the hernia repaired at the same time so this cuts down on hospital and anesthesia time that they would have to pay for.
   — Patty H.