Question:
Does any one have a sample letter?

I am looking for a sample letter that i can have my doctor copy to send into my insurance company. I would like to be well prepared for my vist with my general MD. My insurance requires my Primary send in a letter of recomendation for approval. — Barb P. (posted on January 5, 2004)

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January 5, 2004
Go to the library and seach for sample letter...you should find some there. Good luck.
— AmyWollet

January 6, 2004
I wrote a letter to my PCP requesting he write a letter to my surgical center backing me for WLS for the purpose of insurance approval. In my letter to my PCP I listed my dieting history both medically and non medically suprvised, I listed all my other health issues which are or could be attributed to being MO. My doctor just told me that the letter I wrote him was so detailed that it really helped him to write the letter he needed to write and he thanked me for being so thorough. I can tell you I didn't have even 1 insurance SNAFU, so feel free to visit my profile where you can copy the letter and use it if you would like. Good luck, Angie
— Angie Taylor

January 6, 2004
Hello! I firmly believe in being overly-prepared! I had BTC send a large packet of information to my insurance company that very explicitly detailed my struggles and documentation of life as a morbidly obese person. I'm including the letter that I wrote to the insurance company below, but I have lots of other stuff (from weight charts, letters you can get other doctors to write, such as OB/GYN, family doctor, etc.)....if anyone wants the other stuff, email me and I'll email it to you....email me. TO: BC/BS of Michigan FROM: Xxxxx Xxxxx Xxxxxxx Pol. # xxx-xx-xxxx DATE: May 31, 2000 RE: Request for Surgery Approval I am writing to request pre-authorization for surgical treatment for morbid obesity. The procedure that I will be having, with the surgeon's recommendation of course, is Roux-en-Y Gastric Exclusion. This operation has been shown to have the most beneficial outcomes, with less complications post-operatively than the other options. My surgeon will be Dr. Xxxx Xxxx Xxxxxxx at the Bariatric Treatment Center (BTC). I have researched doctors and centers thoroughly and have found BTC to be highly recommended. I want you to know that I am highly motivated, educated and determined and have the skills, desire and tenacity to make this procedure a success. It's not an easy decision to make, and it's not a cop-out in any way....I've struggled for over twenty years and I am tired of struggling. Other than the physical problems I've listed below, there comes with being morbidly obese a very emotional roller-coaster that I live with from day to day......it's hard to explain to someone who isn't obese, but even simple things like having people stare and having to buy clothing at the "fat-store" is humiliating....and this is not even including the emotional trauma of not doing things in life for fear of humiliation....something simple like not attempting to ride a roller-coaster at an amusement park or traveling by airplane for fear of being told you are too big and the safety bar or seat belt will not accomodate your bulk. I want to be healthy and minimize my risks so that I can re-enter life on a full-time basis for myself and for my wonderful family and I know that this is a last resort for me.....as you can see below, I have made many excellent attempts in the past, and now this surgery is medically necessary. I have enclosed letters from my primary care physician, OB/GYN, reproductive specialist, and GI doctor who diagnosed gross reflux and hiatal hernia, a weight log since 1984, a detailed diet and weight loss/gain history since 1984 and copies of the many weight loss plans and books that I have tried over the years. On the Diet and Weight Loss/Gain History I have left out some of the numerous diets that I tried that I found in books and magazines because I did not remember the exact details pertaining to exact dates and wt. lost/gained. I've tried every one I came across, and have included copies of those books. Also enclosed are copies of some of my numerous weight loss plans and nutrition books as well as some scanned photographs of the many others that I've tried over the years. I am 33 years old, 5'6" tall, and weigh 290 lbs. -- which makes my BMI 48.4. My history is typical of the morbidly obese. I have been on the edge of obesity since childhood. I weighed 145# (at 5'6") in high school and was always trying to diet. After graduation, marriage, and having a child, my weight had crept up to just over 200# and since then I have tried every diet plan and over-the-counter diet medication I could get my hands on. By the age of 22, I was up to 230# and at 25, I was at 250#. Over the past 5 years I have fluctuated between 245-275# and am now at 290# as of my weigh in last week at my T.O.P.S. group. I will describe the effects and comorbidities in a moment. I have never been on a prescription weight loss medication but have tried everything else imaginable, and with the tragedy of Redux/Phen-Fen, I'm glad I chose not to try this new medication on the market. Most recently I considered Xenacal, but have talked to 12-15 individuals who were on it and reported minimal weight loss and unbearable flatulence and rectal leakage of mucous. Most recently, over the past 9 months to a year, I'm finding that when I climb stairs or even go grocery shopping I get out of breath. Oftentimes, when I answer the phone at home, the caller asks if I had to run to the phone because I'm out of breath just from jogging through my small, 1000 sq. ft. house to the phone. I can do a minimal to moderate exercise program for less than 10 minutes (closer to 5 minutes) before physically not being able to continue. At about 260# the pain in my feet, knees, and back began, but I was able to manage by sitting around a lot. This pain and decreasing mobility interferes with any exercise, my job performance and family/personal life. I'm often the outsider watching as others do many of the routine things of life that I should be able to enjoy, such as sports, and even just having the energy to be outside walking the dogs and being with my family more. Now, when I get up in the morning, my ankles and feet hurt so bad because of my weight that I limp around for 5 minutes until they get used to bearing my weight again. Over the past 2 years, I have been suffering from stress incontinence brought on by my obesity. In fact, in 1997 I dieted and was down to 236 lbs. and the incontinence ceased, only to return when I gained the weight back. Now, I wear sanitary pads whenever I am going to be doing anything more than just sitting around the house. Added to my gross reflux and hiatal hernia that I was diagnosed with 3-4 years ago, I'm now experiencing reflux when sleeping that takes my breath away and also symptoms of sleep apnea (extremely loud snoring, involuntary twitching, and feeling just as tired in the morning as I did when I went to bed). As of today, June 1, 2000 I have been diagnosed with mild to moderate obstructive sleep apnea and severe pathological daytime sleepiness as a result of the sleep apnea. I will have my CPAP titration study on July 1st. Over the past several years I have been Amenorrheic and have been unable to get pregnant after consultation with both my OB/GYN and also a Reproductive Specialist. I now take Provera every three months so that I have a menstrual cycle. Through consult and testing with the repro. specialist, we had decided to try some medications and insemination for pregnancy, but I have decided that to get pregnant at this weight would be a risk for myself and a child. Through testing at the reproductive specialist, I was found to be Insulin Resistant, which is a precursor for Diabetes, and can be remedied by losing weight. I am a Registered Nurse and, because of decreasing mobility for certain things, I often have a difficult time bending over and performing job duties for my patients, and often worry about what would happen if I had to try and do CPR to a patient on the ground.....as it is, I grunt and groan, as well as huff and puff when bending over or squatting down. I have made numerous attempts to achieve weight loss by dietary means and have been on the following diets, weight loss programs, medications, and exercise programs: 1200 and 1500 calorie diet plans, Weight Watchers, T.O.P.S., Health Club Memberships, Richard Simmons, Fit for Life, Sugar Busters, McDougall Program, Eat More, Weigh Less, Your Perfect Weight by Prevention, the 5 Day Miracle Diet, the Pritkin Diet, the Weigh Down Diet, This is Living, The Feel Full Diet, Dieting with the Duchess (Weight Watchers), Eat Great & Lose Weight with Suzanne Sommers, Atkins Diet, and the Rotation Diet... and every plan on the book shelf, newspaper or television. Diet Products and Plans: Metabolife, Slim Fast, Dexatrim, Accutrim, ADA diet plan, cabbage soup diet, grapefruit diet, and any other diet, fad or otherwise, that came along. I've been involved with weight-loss support groups over the internet and at work with routine weigh-ins. Gyms and Exercise Programs have included: Vic Tanny, private gym, home gym, aerobics classes at home and at local clubs, water aerobics, Billy Blanks Taebo, and Richard Simmons work-out tapes. I actually enjoy the Taebo and Richard Simmons, but my overall physical status keeps me from doing them....I look forward to losing weight and actually being able to have the energy and stamina to exercise! With my BMI of 48.4, I am classified as morbidly obese and have the following comorbidities: Amenorrhea, infertility, extreme fatigue, pain in weight bearing joints including knees, ankles and hips, high HDL/LDL ratio, obstructive sleep apnea with resultant severe pathological daytime sleepiness that interferes tremendously with daily functioning, hiatal hernia, gross reflux, insulin resistance, occasional peripheral edema when standing/walking for a few hours, stress incontinence (which resolved itself when I lost to 236 lbs., but returned when I gained the weight back -- and for this I am reduced to wearing sanitary pads to prevent embarassing accidents), shortness of breath on exertion (1 flight of stairs leaves me breathless), migraine headaches, heartburn, and irritable bowel syndrome. I found a quote from bariatric surgeon Dr. G. Wesley Clark, of San Diego, who works with another bariatric surgeon, Dr. Alan Wittgrove.....he quotes: "Actually, we're finding that more than 95% of all health problems related to obesity are gone within a year of this surgery," Clark continues. "That includes diabetes, gastroesophageal reflux disease, high blood pressure, sleep apnea, weight-bearing joint problems, pain in the low back, and incontinence.....When you get rid of all the problems you've had, it makes sense you've got a better chance of living longer." I know that bariatric surgery is a big decision, but I've done a remarkable amount of research on it. The the procedure is called a Roux-en-Y Gastric Exclusion, and will be done by the Bariatric Treatment Center at their hospital in Ypsilanti, Michigan that is exclusively for this surgery. It is by no means the easy way out, but I feel that I am ready to do this and to make it a success! I'm 33 years old now but I feel like I'm 50.....and even scarier that the thought of having surgery, is the thought of not being around when I'm 50 ~~ I've really come to terms recently with the fact that you don't see very many, if any, fat senior citizens. Between myself and close follow-up with my doctors, I am sure that me and my very supportive family can, and will, make this a success. It's time for me to re-enter life on a full-time basis and be the best that I can be -- for myself and for my family. I believe that all coverage criteria have been met, and in fact, I have provided you with everything necessary. We have met the "medical necessity" criteria and the procedure is not excluded. Enclosed you will find specific information from Bariatric Treatment Center; my psychological evaluation results; sleep study results; EGD results that show gross reflux and hiatal hernia; health history/comorbidities; weight loss programs, meds and exercise plans/programs I've used; a letter to my doctor outlining my plan and associated physical and emotional problems; letter from my personal care physician; letter from my obstetrician/gynecologist; letter from my reproductive specialist; a weight loss history since high school; a diet history since 1986; and photocopies of the numerous books and diets I have attempted. I have made everything complete so that I am sure everything has been covered. If you need anything more specific, please let me know.....though I doubt you will, as I have dotted every *i* and crossed every *t* to make this as thorough and smooth as possible for myself and for you. Thank you for expediting my request and forwarding the authorization as soon as possible to Bariatric Treatment Center. (A faxed copy forwarded with the hard copy to follow would be especially considerate.) Please contact me if you require more information. Sincerely, YOUR NAME
— Lynette B.

January 6, 2004
That long letter that I just sent in the previous post was from ME to my insurance company. Here is the one that I actually wrote for my doctor to submit. I told him I would make it easy on him (and especially to make sure that everything was in the letter that I wanted to be in the letter). I actually typed it up at home, leaving room at the top for them to copy on to my doctor's letterhead, and typed his exact signature block at the bottom. All the clerk had to do was copy it onto letterhead and have him sign it....he was quite willing to do this! Anyway, here is that letter: To Whom It May Concern: This letter is regarding Xxxx Xxxx Xxxxxxxxx. Mrs. Xxxxxxxx is a registered nurse and is motivated, educated, and able to understand all aspects of surgery, recovery and long-term follow-up. She has been a patient of mine for several years (March, 1994 to present) and we have discussed her obesity as it relates to her health. In March, 1994 her weight was 242 lbs. and it is now 290 lbs. At 5'6" tall, her BMI is 48.4, which classifies her as morbidly obese. She has kept a weight loss/gain record of all the different methods of exercise and diet plans she has tried over the years. Xxxx knows that her morbid obesity increases health risks and has expressed a desire to lose weight throughout the years, and in fact, every time she came in, I talked to her about that. I have talked to her in great detail about the harm that occurs from being overweight. She has tried many different diets and has gained and lost weight over the years and is now heavier than she's ever been. In the past, I have provided her with a 1500 calorie weight reduction diet, but without lasting results. Most recently she is reporting shortness of breath on exertion, pain in her knees, hips and back, fatigue, occasional reflux when lying down, and stress incontinence. In the past, Xxxx had made emergency room visits related to chest pain and, after hospital admission and diagnostic testing was found to have a hiatal hernia. She is now reporting symptoms of sleep apnea and has been referred to a pulmonologist for consult. She has a history of a high HDL/LDL ratio, bilateral lower extremity edema related to extended walking/standing (on 2 or 3 occasions, which resolved overnight), and migraine headaches. On her most recent visit of April 12, 2000, I notice that she was short of breath with speech, but she has been reporting some cough and congestion over the past 2 weeks, for which Vibramycin was prescribed. Sincerely, Dr. Xxxx Xxxxxx, MD
— Lynette B.

January 6, 2004
Oooops, sorry! You can email me at [email protected] for that information I mentioned below.
— Lynette B.

January 6, 2004
Sharon Brittain has a really good letter on one of her websites, and she doesn't mind sharing. I used it and formulated it to my own situation. I thought it was excellent!! Thanks Sharon! for helping me get approved.
— bufordslipstick

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