Question:
What should be in my letter of medical necessity?

My GP finally gave me a letter of medical necessity but I don't think it is good enough and it doesn't include ALL of my co-morbidities. I told him I thought it should include my incontinence and a few other things but he said that there should be enough information in it to make a determination. Should I send it anyway or should I go to another GP and have a better one written. My ob/gyn and my orthopedic surgeon are also writing letters of medical necessity. Heres what my GP wrote: This letter is to serve as documentation of medical necessity for surgical treatment and associated medical care for the treatment of morbid obesity as outlined below. I serve as the primary care physician for ----, a 36 year old caucasian female who suffers from morbid obesity. Her current weight is 262 pounds, height five feet, two inches. this calculates to a body mass index of 49. In addition to morbid obesity, comorbid conditions include, obstructive sleep apnea, chronic leg pain, dyspnea, dysfunctional uterine bleeding, GE reflux disease and elevated cholesterol. Thes comorbid conditions are directly related to her obesity. The patient has already employed several weight loss measures unsuccessfully. These include home dietary regimens, Weight Watchers, medically supervised weight loss and exercise programs, hypnosis, and prescription weight loss medications. Despite these efforts, her weight still remains significantly elevated as noted above. I am requesting authorization for surgical consultation and possible surgical intervention for the treatment of morbid obesity, which may include gastric bypass surgery or vertical banded gastroplasy. It has been proven that surgical intervention for obesity in cases of refractory morbid obesity is the most effective and long-lasting weight loss measure available. If obesity is not corrected in this patient, significant comorbid conditions will continue to develop.    — K T. (posted on March 17, 2001)

March 17, 2001
wow, i wish my doctor would have written such a good letter for me. it reads really well. have you submitted it yet? i think that you will have luck with that letter.
   — enriqueta C.

March 17, 2001
The letter I sent in with my request for approval was almost word for word the same letter, although I don't have GERD. I was approved first time out within 2 weeks. (I have Aetna PPO.) I don't think that the urinary incontinence would make any difference because they will treat that as inconvenience (major pain that it is) rather than something that requires medical intervention. I think you will have success with what you already have. Go for it.
   — Mary H.