Letter of Medical Necessity...

[jessress87 0]

I'm in the process of filling out my packet for the Surgeon's office and one of the things that it tells me to do is include a letter of medical necessity, it says

'A letter of medical necessity that is typed or neatly written by you explaining why you feel it is medically necessary for you to have surgery.'

I know that my surgeon is going to be writing one for the insurance company also but apparently they need me to write one too. Has anyone else had to do this? I've found a couple examples on line but I was hoping to hear from someone with experience. Thanks!

[plain 12]

Well, the bright side of this is that basically they're asking for your opinion of why you think you should have the surgery....and if it's your opinion, then they can't ever tell you you're wrong!! I'd throw everthing but the kitchen sink in a letter like that: improved quality of life, improved general health, improved self esteem. Throw it all in!! Nobody can dispute your opinion.

[dandeegan 21]

I did not have to do this. I have Aetna HMO, and other than the tests I had to get done (sleep study, pulmonary function, stress test, upper GI, and so on) the only thing that was required was paperwork from my primary care doctor. He had to submit my "weight loss management history" IE documentation of how he's worked with me on weight loss for 6 months. He also had to write that necessity letter. Once all that got submitted I was approved in a week. This was with a 50 BMI, sleep apnea and high blood pressure though.