Will This Suffice?/PCP letter

I went to see my PCP yesterday.  I am trying to have all of my ducks in a row for when the surgeon’s office submits my proposal to CIGNA OAP.  So, I tell my PCP (who I have seen all of twice, this being the second time) that I am planning to have WLS. She chastised me for about 15 minutes on how it is not going to work without diet and exercise.  She also tells me that I would have to get my eating habits under control and get off my butt and exercise.  One; she does not KNOW me.  Seriously, to know me is to know I am very active.  It has been difficult as of lately with this edema (left ankle) but I could walk circles around this chic without issue.  WALK…NOT RUN, hell yeah.  I digress....

So short of me having to threaten to meet her outside, she finally says with a big sigh that she will write 'something' for me.  This is verbatim what she wrote:

referral to bariatric medicine obesity
patient has tried several diets in the past and has continued to gain weight. referred for possible gastric by pass surgery

That is complete with misspellings, no capitalizations and the whole gamut. That is VERBATIM.  I want to have the lapband and not the bypass.  I clearly stated that to her.  Will this pose an issue with CIGNA? Should I ask her to rewrite this? 

I would tell her to rewrite it. My letter from my PCP stated my years of obesity, my doc supervised diets, my co-morbidities and my exercise plans. Heck he even threw in my family health history.

You don't want to give Cigna a way out.

Naw, this isn't going to work for you.  On this site  go on the home page, find the search function its in the upper right hand corner and put in "sample PCP letter"  - OH has some sample - the samples I saw were for gastric by-pass but you can substitute lap-band info in that part.  The most important things to have in your letter is stuff like the following:

Is there an old doctor you have that knows you better.  They can't make the referral to the surgeon but they can contribute their 2 cents in a letter.

1. Your weight loss history - weight now, weights through the years - go on line and see if you can find Cigna's WLS medical policy bulletin that shows the exact criteria they use to approve surgery.  Be careful - some insurances require a bmi over 40 for a certain period of time - unless you are dealing with co-morbidities.

2.  Your diet history - everything you have tried to lose the weight.

3.  any health issues - I considered myself basically healthy although overweight - my 202 cholestorol became "elevated cholesterol" my achy knees was "the beginnings of osteo athritis"

Doctors are generally busy and don't want to work too hard filling out forms or writing letters so if you can do most of the work for her she might be willing to sign off on what you have written.  My doctor had his physician's assistant write the letter for me and signed off on it.  If she balks, I would consider changing PCPs.

Best wishes,

Rhonda

I agree w/ the replys thus far. 

Make a strong enough case going in, giving Cigna little to come back with an arguement over.  Initial denials by them (any ins.co) are delay tactics and an appeal can be exausting & time consuming for you.  The thinking there is the patient will go away & forget about it, saving them $$$.

Less is not more in this situation.  

Best wishes for approval!

I have 40+ BMI, plus notes/charts from other doctors listing my comorbities.  I also have 36 mnths (although they only request 6mths) of weight and diet history.  This was from a physician who mainly does weight loss/nutrition programs.  All of the extra fluff I have covered.  I just needed a referral from a PCP.  Her three vague sentences is the issue.  I am wondering if I should go to the physician I went to before and ask that he write a referral.   I think I will do that.

When I read what she wrote I did ask if she could provide more information but she said it is "sufficient".  Yeah... So going back to her for a letter is a negz