Question:
Should I have to pay for a letter of medical necessity?

At a recent visit to my PCP, I told him that I was considering wls and asked his opinion. He said he had many patients who've had it done and he would recommend the surgery to anyone who's health was at risk due to their obesity. So I asked if he would write a letter for my insurance company and he said yes. After waiting over one month for the letter, I'm now being asked to pay because there's a charge for preparing it. I find something very wrong with this, since I didn't just choose a PCP at the last minute to do this, but this is a doctor I've been going to ever since I moved here. Has anyone else had to pay for a letter of medical necessity? I would like to know, maybe I'm wrong to feel upset about being asked to pay.    — dandjon (posted on April 6, 2001)

April 5, 2001
He's your primary care physician! It's his job to prepare the letter for you, so I'm not sure why they're asking for money. Didn't you pay a co-pay when you went to ask him for the letter in the first place? That, plus whatever the insurance paid for the visit, should be sufficient compensation for the letter. What a jerk! I would try to convince him to write it without a charge and if he refuses, I would contact your insurance company directly and file a complaint. He has been chosen as a participating provider, but he is engaging in unfair practices.
   — PT LawMom

April 6, 2001
First, let me state that I do not think you should have to pay, but to be honest, it may fall under the 'life's not always fair' category. . Second, how much does he want you to pay ? If it's a $10 processing fee or something, that's one thing..but if it's more money, it bears definite consideration. Third and possibly most important, while you *shouldn't* have to pay, it may be better to just do it and smooth the way than to have your PCP disgruntled at you or anything. Getting this surgery approved can be really hard and the last thing you want is more roadblocks in your way because a (possibly) nominal processing fee created negative feelings between you and your PCP. It's your decision and I think a large consideration is the amount of the fee. My two cents and good luck with your decision!
   — Anita N.

April 6, 2001
No way!!! I wouldn't pay for such a letter. That's ridiculous. That's his job! I would get a referral to a surgeon and I am sure the surgeon would do it at no extra expense. Mine came from the surgeon and not my primary as my primary didn't agree with the surgery to begin with. Best wishes,
   — mrs.qtip

April 6, 2001
I don't defend doctors much, but let me explain something. You are paying for the doctor's time in writing the letter. He first has to pull the information from your file, (unless of course, you naively think that he has your personal history memorized), dictate a cohesive and in-depth letter, then proof and sign it. This activity takes away from the time he would be earning money seeing patients. I think you should say graciously, "Of course, I would be happy to pay for your time in writing the letter, Doctor. Thank you for your support."
   — merri B.

April 6, 2001
I talked to my doctor about a letter of MN & she agreed. I went home, wrote the letter, faxed it to her. She read it, signed it, & faxed it back to me the same day. I've done this several times, with several doctors through the years when I needed something. It saves them lots of time & I get what I need. ---->>
   — [Deactivated Member]

April 6, 2001
I called several different surgeons offices to get their packets of information when I decided to pursue WLS. They each did a different procedure so I got a good variety of information. One of the surgeons who did the LAP RNY charged a $50 fee to write the medical necessity letter to the insurance company. I ultimately went to a surgeon my PCP referred me to who also does the LAP. The one who charged the fee is one of the first in my area to do the LAP and therefore has done a lot of them. If I had chosen to go to him I wouldn't have complained about paying the fee because his office has a great track record of getting insurance approvals and I guess in this case experience talks. I do not agree with charging the fee but I realize his time is money.
   — debathens