Letter of Medical Necessity

[lnmlisa 1]

Hello... I just have a quick question. My surgeon requested I try to get a letter of medical necessity from my PCM, the surgeon said that it if I didnt get it, it was ok, it wouldnt stop me from having surgery, I was just wondering if anyone else had to get one and what exactly did it say? I requested it from my PCM and they said they could do it, but I just wanna know what it is??? Thanks in advance, everyone on here is so helpful!

[jujuvee 0]

I wrote one and my doc just added a few thing and sent it in along with my 6 month documented visit

I included weight, family history, co-morbidities that were directly related to my weight, failed attempts at weight loss, including ww, Atkins, over eaters annon, zone, I even added Richard Simmons programs.

It mentioned that I had failed at physician supervised plans as well and that all this was not a lack of effort or non compliance because I was good at keeping journals of food eaten, I was good at keeping appointments and going to support groups but that I needed bariatric surgery intervention.

And then it ended with my doc sating that he strongly recommends lapband, and that he felt that I have the knowledge to use this as a tool to achieve and maintain a health weight.... and that he believed that without sergical intervention I was at an increased risk for rapid progression of chronic illnesses associated with increased morbidities and mortality.

of course you want your doc to copy it write it in the 3rd person, so it sounds like it's coming from him, not you!

Hope this helps.

[1RockinMom 0]

I guess it depends on your insurance company and what they want. My insurance company covered my band, my letter, which i got from a GYN Dr., was probably 4 sentences long. Good Luck!

[pottergirl 0]

Hello... I just have a quick question. My surgeon requested I try to get a letter of medical necessity from my PCM, the surgeon said that it if I didnt get it, it was ok, it wouldnt stop me from having surgery, I was just wondering if anyone else had to get one and what exactly did it say? I requested it from my PCM and they said they could do it, but I just wanna know what it is??? Thanks in advance, everyone on here is so helpful!

My Primary Care charged me 75.00 to write the letter of medical necessity to my surgeon to be submitted to insurance (spelled something wrong and marked it out with a pen on the letter...) I was appalled that I had to pay for the letter when my insurance covers bariatric surgery...still a little confused about that one! Oh well, nothing was going to keep me from getting the surgery done!

[Jaffa 5]

I did get one, but mainly to keep with my taxes. If I was to go through an audit, I wouldn't want them trying to exclude the surgery as cosmetic because I didn't have proof of medical need.