Question:
Reasons that make the surgery medically necessary?
My insurance says that surgery must be medically necessary. The Dr. that I have chose to see needs a letter of referal that gives reasons why I should go see this Dr.. I just want to make sure that I do everything right and don't give the insurance company any reasons to not ok the surgery. I have depression (have been hospitalized), reflux, and have weak ankles and knees. Other than that there's not much wrong with me. I don't think that my insurance company will think any of that makes the surgery necessary. Although I have tried to commit suicide twice. What are some of the reasons that would make this surgery necessary? Help, please. — Erica C. (posted on May 25, 2000)
May 25, 2000
There are many conditions that can be called medically necessary. You have
named some in your question. Also what is your BMI? If it is over 40 you
can be classified as medically necessary on weight also. Check out
examples of letters on Clos.net for more info, it really helped me. Hope
this helps and good luck.
— Donna A.
May 25, 2000
hi there!
i bet you have some co- morbs that you didnt think you had! how about sleep
apnea?? did you get tested? what about irregular periods? swelling in your
ankles and legs? what about your BMI ?? depression you said you have ,
what about urine incontience? High blood pressure? are you breathless when
you do simple tasks or climbing stairs? have you been tested for high
cholesterol? or diabetes? all these could be co- morbidities!! i hope this
helps
— kakykeke
May 25, 2000
Hey Erica: Please be sure to check your family history thoroughly for
predisposition to other problems. My family has diabetes (late onset),
hypertension, cancer, heart disease, arthritis, etc. If someone in your
family has these types of symptoms, list them too as you will be likely to
develop some of them without this surgery. Good Luck in the approval
process.
— Dot W.
May 25, 2000
Below is a good site for researching DEFINITIONS OF OBESITY AND
CLINICALLY SEVERE OBESITY along with non-surgical and surgical treatment
for clinically obese, as well as risks and benefits..
<p>
<a
href="http://www-surgery.med.ohio-state.edu/divisions/genr/obesity.htm">Definitions
of Obesity</a><br>
<p>
Visit my profile page for more information, links and recipes
<p>
<a
href="http://www.angelfire.com/ok3/vbowen/index.html">Gastric
Bypass Information, Recipes and Support</a><br>
— Victoria B.
May 26, 2000
Check out "Beyond Change" lots of good inspirational stories
and articles and research on abesity at your finger tips.. Below are
just a few of the articles in this month online issue..
<p>
Health Benefits and Risks of Weight Loss & The Role of One's Mood on
Weight Gain and Overall Health
<p>
<a href="
http://www.beyondchange-obesity.com/index.html">Beyond
Change</a><br>
<p>
Visit my profile page for more information, links and recipes..
<p>
<a
href="http://www.angelfire.com/ok3/vbowen/index.html">Gastric
Bypass Information, Recipes and Support</a><br>
— Victoria B.
May 26, 2000
— Victoria B.
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