Question:
Will I be covered...

I have checked most of the peers and can find any one with the same insurance as I have.In my ins. book it states that obesity/weight control is not covered. I called my insurance and talked to a lady and she said " if medical nessity" the doctor isn't in my network either, I am well over 100lbs. overweight, with arthritis.What kind of letter should I have my doctor here write to help me get approved. I have a appointment with Dr. Gaar, 5 hours from me and I sure NEED some advice if I can get approved. This waiting game is hard. The not know is killing me.    — lyn K. (posted on March 24, 2001)


March 23, 2001
The way I went about it was to go to my primay care physisican, who was more than willing to help me with whatever we needed to document my need for the surgery. (Calculating bmi, blood tests, diabetes testing, perhaps if one needed, even x-rays to prove joint deterioration) Have your pcp compile a list of all obesity-related medial conditions which could be lessened or cured with wls. He/she will be able to put togehter a letter of need listing your current height/weight/bmi stats, medical status/conditions, how this surgery can help you as an individual, and then perhaps a little blurb on statistical benefits of surgery for the morbidly obese population. I also had a letter written by the bariatric center I am using (they actually wrote the main letter that was sent to the insurer, and the pcp's letter was just used as further proof-- the model I used for a good letter format is based on the excellent letter sent by the bariatric center, my pcp's letter was surprisingly short and I felt like he left out a lot of helpful info.) Anyway, I hope that helps to get you started!
   — Holly D.

March 24, 2001
Also, check to see what surgeons are in network for you. You may be surprised to find that one of your in network surgeons also does this surgery. If your insurance company has a web site, they may also have a way for you to search for an in network doctor.
   — Dee P.




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