Letter of Medical Necessity......

[Shellyin KY 0]

This is all so new to me as I begin my journey. I understand what a letter of medical necessity is and why I(or my insurance) would need one. But my question is what should the letter contain and who should write it?

Thanks in advance

New Me Desired

[manderky 0]

This is all so new to me as I begin my journey. I understand what a letter of medical necessity is and why I(or my insurance) would need one. But my question is what should the letter contain and who should write it?

Thanks in advance

New Me Desired :ohmy:

Not sure what the letter should contain, aside from how the surgery is necessary, because my surgeon took care of that. They sent it to the ins company with my other paperwork. Perhaps ask your surgeon if they do this as well?

Now, I had to have a letter of medical CLEARANCE from my primary care physician for my insurance also. My PCP faxed it to my surgeon and they sent it in to the ins company also. It basically states that I don't have any medical conditions that would make it unsafe for me to have surgery.

HTH!

Amanda in KY

[annecolorgreen 0]

Amanda--

I had the same question! I haven't spoken yet to my PCP but my GYN said she would do it if the PCP refused. I am still trying to figure what my insurance covers and doesn't (prior to even seeing a doctor). Do you mind saying where you went and why? I went to a seminar at St. Mary's.

Thanks!

~~anne

[manderky 0]

Anne,

I went to St Mary's also. My surgeon was Dr. Lusco in their group. As to why I went there, probably because back when I was looking for info, they were the first ones that I found a seminar for that was coming up sooner rather than later. I went to the seminar and never looked at anyone else, other than a quick internet check.

I am very pleased with the care that they provide at St Mary's though. Everyone there was very pleasant and helpful. I'm happy to answer other questions if you have them. :thumbup:

[Shellyin KY 0]

Hey Amanda,

I attended a seminar just last night (July 22nd). Dr Lusco was the speaker. I, along with my husband, was very impressed. After leaving I am even more determined to see this through. Lana has already been very helpful and seems genuine.

Do you care to share any information about self pay or insurance? any complications with either? How long did the process take from start to surgery?

I have Blue Cross Blue Shield insurance and it is covered. Dr. Lusco's group and St Mary's Hospital are in my network. Yeah!!!! Do not require supervised diet or specific amount of weightloss prior to surgery.

Looks as though things are going good for you.

What the hardest thing(s) that you have encountered during the LAP BAND journey?

Looking forward to hearing more from you...

Shelly:biggrin2:

[annecolorgreen 0]

Hi Shelly!

I have an appointment with Dr. Lusco on August 18th. Hopefully, I'll find out more then about whether or not I can have sugery right away or if I have any hurdles to jump through first. I also have anthem and the doctors and hospital are "in network" although there was some initial controversy that they weren't (which has been straightened out).

I actually went to the seminar last month and just now got this far! It sounds like you are doing much better with your insurance company!

We'll have to keep in touch!

~~anne

[nursenky9 0]

Hi Shelly, I have highmark bcbs ppo. The ins. co received my paperwork on 7/7/08. My initial 6 mo supervised diet was on 6/26/06. The ins requires 6 mo cumulative supervised diet 2 yrs prior to surgery. They will not use the 6/26 of course b/c it is over 2 yrs. Just found this out today. Getting very disappointed.

I have to come up with another month. Good luck to you!! I am in Lex, KY

[manderky 0]

Shelly,

My insurance covered the surgery - I have Anthem Blue Cross Blue Shield through my husband at UPS. We have an 85/15 plan, and I ended up paying a little over $500 out of pocket. Thankfully, since Anthem is in network with Dr. Lusco I didn't have to worry about the $4000 extra charge.

From the time I attended the seminar to the time I had surgery was about 8 months. It could have been much shorter, but that was during Christmas and I had to see my PCP, and I did drag my feet a bit with making appts and returning phone calls.

Things are going well - I'm still learning how to eat, LOL. My first fill did not provide much additional restriction, so I haven't lost much since my surgery, but I had a second fill today and so far have noticed a definite difference. Dr. Lusco gave me a good analogy for how the fills tend to work. He said the first one gets you in the neighborhood, the second one gets you on the street, and the third one gets you to the house.

I would say the hardest part for me is head hunger and controlling my evening snacking. I don't eat as much during the day, since I'm busy at work, but after I get home and the kids are in bed, I stay up late and snack. I also am consuming more calories than I think I am at the time. I'm going to start tracking them to see where I need to improve.

Let me know if you have other questions!

Hey Amanda,

I attended a seminar just last night (July 22nd). Dr Lusco was the speaker. I, along with my husband, was very impressed. After leaving I am even more determined to see this through. Lana has already been very helpful and seems genuine.

Do you care to share any information about self pay or insurance? any complications with either? How long did the process take from start to surgery?

I have Blue Cross Blue Shield insurance and it is covered. Dr. Lusco's group and St Mary's Hospital are in my network. Yeah!!!! Do not require supervised diet or specific amount of weightloss prior to surgery.

Looks as though things are going good for you.

What the hardest thing(s) that you have encountered during the LAP BAND journey?:smile2:

Looking forward to hearing more from you...

Shelly:biggrin2:

[cheryl1952 0]

Why did you decide to go to Louisville? Are you not pleased with the hospital in Lexington? That is where I am planning on having my surgery. Please let me know if you know something I don't.

Cheryl

[Shellyin KY 0]

Actually, I did not even consider Lexington. I am about 150 miles from Lexington and only 90-ish from Louisville. I live in the Mammoth Cave area of KY near Glasgow.

When I decided to go to Louisville I did alot of homework on the doctors. I have decided to go with the Olsofka Group (Olsofka, Lusco, and Schuster). This forum has provided alot of valuable information. Most that I have seen post like this group of doctors and were satified. I have my consultation on the 29th of August. All that my insurance requires is a letter of medical necessity from the surgeon for approval. Then once approved, they do require a psych evaluation.

Where are you at in the process? Who are you seeing?

Shelly:thumbup:

[toribug1 0]

Can anyone help me. I live in Louisville and I have to do The 6 months with a doc but my PCP doesnt think I need lapband. Does anyone know who I can see just for the six month diet??

[2b-banded 0]

Can anyone help me. I live in Louisville and I have to do The 6 months with a doc but my PCP doesnt think I need lapband. Does anyone know who I can see just for the six month diet??

Dr Nigam who is in plaza 1 attached to St Mary's. She does a lot of the 6 month diets, and knows what to put in the letter. It's I think $90 the first visit, and 45 each time after that. Most Insurance doesn't cover the 6 month diet. You could also call the bariatric center you want to use, and see if they have any suggestions.

[jenn.ifer 0]

Hey Amanda,

I attended a seminar just last night (July 22nd). Dr Lusco was the speaker. I, along with my husband, was very impressed. After leaving I am even more determined to see this through. Lana has already been very helpful and seems genuine.

Do you care to share any information about self pay or insurance? any complications with either? How long did the process take from start to surgery?

I have Blue Cross Blue Shield insurance and it is covered. Dr. Lusco's group and St Mary's Hospital are in my network. Yeah!!!! Do not require supervised diet or specific amount of weightloss prior to surgery.

Looks as though things are going good for you.

What the hardest thing(s) that you have encountered during the LAP BAND journey?:wub:

Looking forward to hearing more from you...

Shelly:biggrin2:

Hey, from everything I have read, BCBS requires 6 months, is there a way around this? Thanks, Jennifer :smile2: