Help Writing Personal Letter of Necessity

[3loves 0]

I could use some help writing my own so-called "Letter of Necessity" to include in my packet that goes to my insurance to get initial approval. I understand the offical L of N will come from my surgeon, but I rec'vd some good advice today that it would benefit me to write a letter myself stating my personal reasons I feel the surgery is necessary. Even though I have many years of admin in my background, I am drawing a blank on verbage. Does anyone have any suggestions or places to find sample letters? I just want to cross all my t's and dot my i's to avoid the appeal process and get approval the first time around. Thanks a million!!

[ljones4521 4]

Try www.getinsuranceapproval.com. This person also posts on this site. Maybe you can do search.

I have also attached a .pdf print out of her website.

gettinginsuranceapproval.pdf

[3loves 0]

Thank U....I'll check out that site. I tried a search on this site and couldn't find what I was looking for. Any suggestions on searching this site for such a letter?

[ljones4521 4]

Sorry, I don't have any other suggestions, as I am uninsured and didn't have to even consider fighting the insurance companies.

Have you tried reading the Insurance forum here? A doctor posted the insurance code for hte procedure. Not sure how that can help..but who knows.

Hey, contact those people who have been approved. Maybe they can offer valuable insight into the process.

Lisa

[3loves 0]

~Thanks~ Lisa. I did confirm with my surgeon that they are using the new lapband code. Maybe I should just let it ride the way it is since I know that I've met all the requirements they requested when I called the make sure they do pay for the lapband.

My insurance is NGS-American. Do you know of anyone that has had any experiences with them....good or bad? Also, our company is self-insured so does that mean if they deny me that I can go to somone in the company to get that decision over-ridden (is that a real word)??

[HarleyNana 10]

Sorry self pay, wish a letter would have done it for me, good luck.

[ljones4521 4]

found this on thw web. maybe it will help.

insuranceinformation.pdf

[Jammin & Losin 1]

Sorry but my Drs. office did all the writing for my letter of necessity! Glad I didn't have to do any letter my self! Good luck getting approved.

[3loves 0]

O.K. I decided to go ahead a write a letter since I don't have any co-morbidities and perhaps it will let them know I'm not willing to take "no" for an answer. Here is the letter I wrote and I would appreciate any feedback since I will be sending this to my surgeon tomorrow.

I am writing to request approval for Laparascopic Adjustable Lap-Band surgery. I am 5 feet 5 inches tall and weigh pounds. My current body mass index is 43. The degree of obesity associated with my BMI is morbid. I am having significant adverse symptoms from my obesity including:

Swelling of feet and legs, knee pain, achy joints, and pain in my heels if I am on my feet for any length of time. I am also very tired all of the time. These symptoms make it very challenging to go about normal daily activities such as grocery shopping, cleaning house, and fixing family meals. In addition, I am the mother of two beautiful pre-school children and I am very sad at times that I don’t have the energy to participate and play with them in the manner in which I would like to because of my weight.

Depression. I suffer from depression and take Effexor XR daily. I face constant challenges to my emotions, repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. Emotional suffering is probably one of the most painful parts of being overweight. I feel the stress related to this plays a huge roll in the number of headaches and Migraines I suffer, for which I take Relpax as needed.

Skin rashes. I have persistent rashes in the folds of my body due to my obesity. Obesity creates these folds so that skin rubs on skin and the moisture trapped in those creases causes infections and rashes. I have used over-the-counter remedies to no avail.

Urinary incontinence. I need to wear protective pads at all times. A large heavy abdomen and relaxation of the pelvic muscles may cause the valve on the urinary bladder to be weakened, leading to leakage of urine when coughing, sneezing or laughing. This condition is strongly associated with being overweight and I believe this will be relieved by weight loss.

Family history of hypertension and diabetes. Although I am currently not diagnosed with hypertension or diabetes, I did experience hypertension during most of the pregnancy of my first child. I have also experienced a few recent incidents of elevated blood pressure during my recent doctor visits. It is one on my biggest fears to develop high blood pressure. In addition, I have the following family members that are currently under a doctors care with these conditions: Mother – hypertension, type 2 diabetes, Father – hypertension, type 2 diabetes, heart attack, Brother – hypertension. I also have many extended family members with these conditions as well. I understand that my obesity places me at greater risk for hypertension and type 2 diabetes, as nearly 80% of patients with these diseases are obese.

I have made many attempts at losing weight over the past seven to eight years as you will see documented in the attached paperwork. I have included exercise with all weight loss attempts and have been able to lose some weight, but gained it all back and more.

Given my adverse symptoms of obesity described above, I respectfully ask that you approve my application for Laparascopic Adjustable Lap-Band surgery. Thank you very much for your time and consideration given to this matter.

[Mvpo8961 1]

I would suggest you say that you are fatigued most of the time instead of very tired. Also in the family history paragraph I would cut out the

Although I am not currently diagnosed with hypertenstion or diabetes, and Just let the sentence begin where you say I did experience ...

No need to put it in front of their faces that you don't have those diagnoses yet. Let them glean that from your chart.

I wish you luck. M

[3loves 0]

Great advice...I agree...I will make those changes b4 it goes out tomorrow. Thanks a bunch!!!

[3loves 0]

Thanks Indababy!! Feel free to use any or all of the letter. I pulled from many sources and found this format which seemed to suit my needs. Oooppss.....I wished I had found that misspelling of "roll" b4 it went to NGS. I can't tell you how many times I read over the letter and didn't even catch it. That's why I like for other eyes to check out my writing.

The letter was not my idea....it was suggested by a previous lapband patient with my surgeon (I guess she also comes to this site). I called my insurance to get some info and I ended up talking to someone that had the surgery with the same surgeon. How bizarre?? It was meant for me to make contact with her. The insurance coordinator at my surgeon's office said she wished more patients would include letters like this b/c it can only help. Best of luck to you as well and keep in touch!! :clap2: