Plastic Surgery: Letter of Medical Necessity

Tammy if you do get any sample letters please let me know. I hope to cover all the bases before I go back to my family Dr. The more educated, the better prepared maybe the faster the process will be, Thanks, Kathi

I'm also looking for advice on a letter of necessity for the surgery itself. My PCP has been absolutely wonderful with the whole process and has assisted me with completing all of what the insurance company requires. He, like myself, wants to make sure that my insurance will cover the surgery w/o having to go through any appeals. He asked me to contact my surgeons office and ask at support groups for advice on what to include in the recommendation letter. If anyone can give me some examples of what was included in theirs it would be very helpful. I see my PCP for my last doc. supervised weight on 3/20 and at this time he will write my letter. Any suggestions.....?

I am not ready for PS but I know I will need it. Does it take as long for approval as Surgery (9 mths) because they denied me etc. Should I be taking pics of the places under my arms ery time I get a rash. Should a see a PS now to see what they say or better off to wait. I also have places on my chest my beast from them drooping and rubbing on my tummy. I ma anscious to see what a dr recommends and what they think they can do too.....

I don't currently have one available, but I'll try to track it down. This site was pretty good for giving me an idea of proper syntax though. It's a good primer for writing a basic letter. www.drrubach.com sara

Tammy, This is the sample PCP support letter that my surgeon included in their Bariactric Surgery Education Manual. Dr.Smith address city, state and zip Fax no. Dear Dr. Smith Jane Doe is a 42 year old patient of mine that I have seen for the past 5 years. She is 5' 6" and weighs 325 pounds. She has been medically managed on mulitple diets and exercise programs for the last 5 years, but has been unable to stabilize her weight. She suffers from diabetes and hypertension. I certainly agree that she would be a good candidate from her past history and review of systems for Gastric Bypass surgery or Laparoscopic Banding. I will continue to follow her as her Primary Care Physician. Please let me know if I can be of any assistance. Sincerely, Dr. Cannon That was to my surgeon. Now, what they have sent papers to my insurance I don't know, except that it is 85 pages long. I just got my reference case number on Wed. the 1st. WAHOO! My nurse had faxed everything to them on the 8th, it didn't get into the system until the 14th and then the insurance needed some more info that I told the nurse to send. She did that on the 24th and on the 1st I have a case number. I've been told that it takes 10-14 days to get a reply from the insurance and then to see the Dr. again and schedule THE DATE. Another 10-14 days out. The Dr.'s I'm going to require seeing a Pulmonologist (which I did a sleep study and have sleep apnea and use a CPCP machine), a behavorial health evaluation, and an EKG and electrocardiogram. They want you to go to as many group support meetings as you can. They really help. I've had back problems for years and with losing the weight will help a lot. After the weight loss I want to have a breast reduction. I never lose there, 42 II. My insurance will pay all of that, then I can have a lift at the same time. I have United Healthcare Plus and it will pay 100% of the gastric bypass. I'm lucky with that. I'll also, have another surgery that will need to be done abdominally, then I can have the tummy tuck at the same time, insurance paid. Has anyone heard of the Shriners doing the skin lifts? Or helping out with it? They use the excess skin for burn victims. I've been hearing a bit about it locally. Just wondering?????? I have been researching this surgery for over a year and in Nov. I started actively, by going to the information meeting and support group. I am hoping that I will be able to have the surgery by the end of March. I've started protein drinks and low carb meals. They want you to lose some weight before surgery. It helps and besides, it will show that you are willing to follow their "bible" for post-op. I've had no problems so far. Just super anixious, as most people are to start the best part of their new life. I've even been making prepared meals to freeze for after surgery for my husband. I know I don't what to be up standing and cooking meals for him while I'm doing my liquid and soft food diet. He has been working out of state since the first of the year. It has made it so much easier for me to quit smoking a pack a week and drinking Diet Dr. Pepper, which the Dr. requires you to do. I was really hoping I would have been able to have the surgery BEFORE he got home, but it may not happen. Anything else that I can help on, just let me know. I am prepared as I ever will be and know the risks, the pros and cons. But, I am confident that I will succeed. Take care, Cathy