Letter Of Medical Necessity And Sample Letter.

[HalloweenBaby24 447]

I know I've asked about this topic a few time's now, But I finally have appointment's this week with my PCP and OB in which I plan on bringing up the letter and my plans for WLS with them while I'm there. My PCP I've only been with her for about 3years and have seen a handful of time's so I thought it was important to sit and talk with her about thing's instead of just faxing over the letter and expecting her to sign it. My OB should have records from my last Dr which date back to early 2009 so I'm hoping she has no issue in signing it for me.

I guess my worry here is that the "Sample Letter" my surgeon gave me to give to the Dr's list a whole slue of thing's they won't be able to provide like 5 year's worth of weigh-ins (My OB yes but the PCP no), one part say's "I have personally supervised Mr/Ms.______ in his/her efforts to lose weight thru diet and exercise" (And obviously neither Dr has done so), and it goes on to ask for a list of diets and exercise..

I'm hoping both Dr's agree that the VSG is the right solution to my weight, But neither have known me for a long period of time or long enough to know I've been overweight since I was a child so I worry they will be against it. How important is this letter regarding the insurance approval and should I be worried that I don't have 5 years of recorded weight from my PCP, or records of me ever going to her with weight related issues?

Appointment with my PCP is tomorrow at 9:20am, Wish me luck!

[Dulce_jtrivera 31]

I am in the same boat you are in. I want to my consult appointment on Monday and the only thing standing between me and a surgery date is this letter and the 5 year records of weigh-ins. I am the kind of person who doesn't really go to the doctor unless it is necessary, so as far as a PCP I don't really have one. I have scheduled an appointment with my OBGYN and I am going to take the sample letter and ask for the weigh ins, but I am scared that they won't give it to me. I have never been on a medically supervised diet, I've always just done my own thing. I'm glad I am not the only one with this concern. Nice to know I'm not alone in the boat! Good Luck!

Edited May 22, 2014 by Dulce_jtrivera

[Pelicanlady 122]

I too am in the same boat. When I have my weight under control I have no problem going to the doctor. When my weight is out of control the last thing I want to do is see and doctor and have to get on the scale. I hope to hear from Dr. Welle's office tomorrow that they sent everything to my insurance.

[LilMissDiva Irene 3,282]

Insurance is really picky when it comes to stuff like this. Is there anywhere you weighed in that was officially recorded? How about places like Urgent Care or Emergency rooms? Maybe Weight Watchers meetings? Get anything you can to gather as much information as you can. Make a long list of all of the diets or medications you might have ever taken that might help your cause. You have some homework to do but it's our job as the patient to put in as much of an effort to get what we want.

This is only one of the many reasons why you will never hear any of us say that weight loss surgery is not the easy way out! It's a lot of dedication, time and even more patience. Good luck ladies!

[HalloweenBaby24 447]

@@LilMissDiva Irene

That's the thing that is holding me back, I contacted WW and they were unable to help me since my account was over 2 years old and from another state. I'm almost wondering if it would be worth my time to track down my medical records from when I had my gallbladder removed in 2007. I live 3 hrs away from the hospital that preformed the surgery and the pcp I had at the time?, well I haven't seen her or stepped foot in her office in 9 years.
I'll let everyone know how it goes tomorrow!

Edited May 22, 2014 by HalloweenBaby24

[LilMissDiva Irene 3,282]

Yes do whatever you have to, even if it's longer than 5 years. All the best!

[Dulce_jtrivera 31]

I can get the weigh-ins from more than one doctor, so that will help. The letter is my big worry. What happens if my Obgyn won't write it? She is really the only "steady" doctor that I have seen other than a pediatrician, and I don't think they would accept a letter from them, even though they are the only doctors that ever put me on a diet. It's been 8 years since I have seen them... just crossing my fingers that the OB will agree that this is the best option for me.

[Pelicanlady 122]

I had my medical records from 1993-1998 that I gave to my surgeons office to submit to insurance. During that time I started at 258 lbs, went on a doctor monitored diet, lost 107 lbs, and then proceeded to gain it all back. I am hoping that will help. Good luck everyone.

[HalloweenBaby24 447]

@

I am kind of relying on the written letter from my OB, Especially since I was just in there for a "Missing Period" and problems conceiving for a second time. She told me to lose weight and try again, so that's the plan. Though an OB is not a "Primary" Dr it is a Dr and I don't think the insurance will have any problem with who they get the letter from.

I see my OB a lot more then my PCP..

[HalloweenBaby24 447]

@

That's great!, I don't really think you'll have any problem with you're insurance approving you.

I guess my medical records are all lost from the past (I assume), Not sure how long Dr's keep old patient records but I can't for see any of my Childhood Dr's keeping them around. I suppose it wouldn't hurt to call around and see.

[Pelicanlady 122]

@ Halloweenbaby24

I figure a doctor,is a doctor and as long as they have your weight that should be good.

[HalloweenBaby24 447]

@

This is very true, I just hope my insurance isn't picky to the point they are like "Well she was pregnant at the time, So she had a reason to be fat!"

Though I've been told they don't need to know that I was pregnant, they just need to see numbers,

But if they were to look into it further they would find out.

[Dulce_jtrivera 31]

My 5 year weigh in will include two pregnancies... let's both hope that insurance isn't that picky and says that those weights don't count. Keeping my fingers crossed that this is a smooth process for all of us!

[HalloweenBaby24 447]

So just an update.

Just got out of my pcp office and she was super cool about everything and told me she would do the letter for me no problem.

She said she would include childhood obesity to it and the list of diets/meds and gyms I had for her.

[Dulce_jtrivera 31]

@@HalloweenBaby24

That is GREAT news! I hope my Ob is as cool about it. This gives me some hope. Yay, one step closer!