Need Sample of Letter of Medical Necessity for Medicare.

[pitter 0]

Does anyone out there have a sample letter of medical necessity for Medicare for lap band surgery? I am trying to get approved and need a draft I can give to my doctor. Any help would be greatly appreciated! Thanks.

[Maya314 0]

I actually found this template somewhere on the web and added a few things to it for my own... What I did for mine was take it to my Dr already typed in and all my Dr did was put it on their letterhead. Good luck!

DATE

To whom it may concern;

I am writing this letter on behalf of my patient XXXXXX DOB XX/XX/XXXX. XXXXXXXX is XXXX tall and weighs XXXXlbs. and a BMI of XX.X with a diagnosis of morbid obesity (278.01). XXXXX has been excessively overweight for most of his/her adolescent and all of his/her adult life and having attempted and been unsuccessful at many different methods of weight loss, would certainly benefit from some sort of bariatric surgery.

In addition to morbid obesity, XXXXX also suffers from the following co-morbid conditions, (These are a few that would qualify you) sleep Apnea (780.57), GERD (530.81), Shortness of breath (786.05), Stress Incontinence (625.6), Back Pain (724.2), Knee Pain (716.98), and has a positive family history of obesity, hypertension, diabetes and hypercholesterolemia.

XXXXX has tried many method of weight loss including a physician administered diet and diet pills in XXXX with an approximate weight loss of XXlbs only having to gain the weight back plus more.

XXXX is limited due to his/her co morbidities in the ability to exercise however is currently (walking approximately XX miles per day) (Or is a member of XXXX fitness club) with a weight loss of XXlbs.

I feel that XXXXX would benefit greatly from the Lap Band Procedure (43770) as a tool to help lose the excess weight and lessen the co-morbidities and regain a more healthful life.

Sincerely,

[pitter 0]

Maya, Thanks so much!!! Was this letter for Medicare approval?

[Maya314 0]

No not for medicare, but they're pretty much all the same, (I work in the medical field) be sure to include medical records supporting the information in your letter and you should be good.

[kristenmh 68]

Thanks so much for posting this! I have to get a recommendation letter from my PCP tomorrow and this is the perfect template.

[MacMadame 81]

Here are some more too ... in case you need something missing from the first one:

Sample surgeon's letter - VSG FAQ's

Denied by insurance? - VSG FAQ's

And here is a series of articles on working with your insurance company:

OAC