Newbie here! Any suggestions or advice on insurance letter?
Was here 5 years ago but this time I"m more determined and serious
about this journey! Am in those early stages and writing my letter
to my insurance company. In your experience, any of you have advice
or suggestions on what to put in the letter...or what to leave out? I tend
to be very wordy :) so trying to do it right the first time! Thank You! PK
I don't think you have to write a letter to the insurance company. I believe your PCP has to write a letter of necessity/clearance. His/Her letter has to list how long you have been obese, what you have tried in the past to lose weight and any co-morbities that you may have. Here is the letter that my PCP wrote. This was done after I completed all of the insurance required appointments.
To Whom It May Concern:
Ms. _____ has been a patient of mine for 6 years. She is 5’6” and weighs _____ with a BMI of ____. She has been excessively overweight for over 6 years and has attempted weight loss without successful long-term weight reduction. Ms. ________ has participated in a physician supervised nutrition and exercise weight loss program with Dr. Kevin Edmonds from 2006 to 2007; a 3 day per week nutrition and exercise boot camp with Body by Tyson from 2010 to 2011; a 5 day per week nutrition and exercise boot camp with Casi’s Boot Camp from 2011 to 2012; and finally a 6 month physician supervised nutrition and exercise weight loss program with myself from July 2012 to the present. She has lost weight with most of the aforementioned attempts, however, she cannot sustain the weight loss and has gained the weight back and even additional weight. I am referring her now for bariatric surgery as all non-surgical options have been unsuccessful.
In addition to morbid obesity, Ms. _________ is suffering from the following co-morbid conditions: obstructive sleep apnea, hypercholesterolemia, prehypertension, tachycardia, back pain, urinary incontinence, occasional anxiety, fatigue, shortness of breath with minimal exertion, frequent headaches and plantar fasciitis.
I feel that Ms. _________ would benefit greatly from bariatric surgery as a tool to help lose the excess weight, lessen the co-morbidities and regain a more healthy life.
Ms. _________ current medical problems are optimally controlled and she is cleared for surgery.
Sincerely,
Dr. _________
Surgery date - 04/03/13; Goal date - 11/10/13 (I reached goal in 31 weeks & 4 days)
Highest weight 261 SW 258 GW 150 M1 -26 M2 -14 M3 -10 M4 -12 M5 -13 M6 -12 M7 -11 M8 -10 In maintenance since November 2013 HT- 5'6"
Your PCP writes the letter. If you go in and talk to them about WLS, they probably have a stock letter on hand (mine did) in which they can fill in your personal info and comorbidities. The letter posted just above me was pretty similar to the one my PCP gave me. I then submitted it to the surgeon's office and let their insurance specialist submit everything to Cigna.
VSG 7/1/13 with Dr. Jack Rutledge 28 y/o female - 5'10" - HW: 298 - GW: 174 - SW: 290 (-8) - M1: 262 (-28) - M2: 247 (-15) - M3: 235 (-12) - M4: 228 (-7 ~First Stall: almost 2 wks~) - M5: 218 (-10) - M6: 209 (-9) - M7: 199 (-10) Onederland on 1/31 - M8: 196 (-3) 100 lb total loss on 2/2 - M9: 192.6 (-3.4) - M10: 188.6 (-4) - M11: 182 (-6.6) - M12: 175.6 (-6.4) - M13: 173.8 (-1.8) CW (7/8/15): 167 - GOAL reached in 1 Year and 25 Days! - TOTAL WL - 131 lbs
I've got a few more months ahead of me I want to make sure that what I'm doing is right for me..do you ever go into it knowing a hundred percent you're making the right decision? I've heard some people say they knew immediately no fears no doubts then I hear people who have fears and doubts even up until the time they were rolled into the operating room... it's scary but is it worth it?....thank you all again
