Any suggestions on getting my PCP to do Letter of Medical Necessity?

[pitter 0]

I have an appt. with my PCP tomorrow (had sent him a draft LMN) and am wondering if anyone has ever had a problem getting their PCP to do a Letter of Medical Necessity. I obviously have the BMI (37.2) and have GERD but included codes for sleep Apnea (for which I have all the symptoms and my dad has it!) but haven't been tested for it, also have high cholesterol and triglycerides and painful joints. Just curious if anyone has had their PCP turn them down. Thanks.:confused2:

[sahm2_2grls 0]

I am wondering the same thing. My BMI is 38. I had an appt w/ my PCP a couple weeks ago to see what her thoughts on the band were and it didn't go as I hoped. She said she that she usually recommends it for patients who weigh 300lbs +. I am not sure where to go from here myself, wondering if I should make an appt w/ a new PCP?

[pitter 0]

My appt. is tomorrow morning. I will let you know how it goes. I sure hope I don't have to try and find another PCP. Since this one has seen me for awhile, I'd think he'd be the best one to do this. I will let you know how mine goes. Did you bring a draft letter for your doctor to sign and show in it the co-morbidities you have?

[shortgal 5]

Your PCP should know what your co-morbids are. I think for a better shot at ins paying you might want to get a real sleep apnea test. I don;t think they will accept, you think you have it. And they will probably want copies of the test for verification.

I would go prepared to tell your PCP why you think the band will be helpful to you and all the other methods you've tried to lose weight ( unless he/she already knows your previous attempts)

Many ins. co. want 2 co morbidities if your BMI is under 40.

Good Luck with your appt.

[Yvonne72 0]

My surgeon gave me a list of doctors to see that were on my insurance that they knows would approve of the surgery. My PCP would never do it. He recommended me to a nutritionist and that was all he would do.

So I have an appointment with a new doctor on the 27th. She will order my pre-tests and I should be good to go by May 1st!:thumbup:

[sahm2_2grls 0]

That is great! My PCP kept insisting that I COULD do it on my own. She actually suggested getting the newest 'Biggest Loser' book and also said that she had a patient who just lost some weight by simply just eating Lean Cuisines for dinner. I was literally in tears while talking to her. But this is good news, I am going to see if I can get the same type of list!

[MacMadame 81]

My PCP suggested WLS before I could bring it up. So I don't think the letter is going to be a problem. But I worry it won't be in the right formate or include all the right details for the ins. company. Because I'm a worry wart like that. There was supposed to be a sample PCP letter in my packet from the surgeon but it wasn't there. Anyone have a link to a sample letter online that I can print out?

[Robin Bird 0]

I had no problem getting a letter from my PCP...and my OB/GYN...and my psychiatrist...and the mailman. I guess they all just took a look at my 300 pound body and jumped on board!! I'm just kidding about the mailman. I do not mean to make light of the situation - it would be seriously frustrating to not know if they would support you. BTW I was banded Nov. 2, 2007 and have lost 63 pounds (about 1/2 of what I'd like to lose). Best of luck to you all and don't give up!

Robin

[pitter 0]

Well, I went to my PCP today and he says he has no problem doing the letter. Yeah! Still it is just one step for me as I am on Medicare and I understand they can put you through some hoops to get approved. Anyone on Medicare ever gone through this before? Any tips or advice?

[shortgal 5]

Well, I went to my PCP today and he says he has no problem doing the letter. Yeah! Still it is just one step for me as I am on Medicare and I understand they can put you through some hoops to get approved. Anyone on Medicare ever gone through this before? Any tips or advice?

Check the "insurance" section on the forum or do a "search". The search box is upper right on the forum page.

I think I read you need to go to a place that is certified as a "Center of Excellence"

[pitter 0]

Thanks! The place I am planning on having the procedure at is a COE thank goodness.