I need approval advice please

One of the (many) things my new bariatric surgeon needs to submit for insurance approval is a "Letter of Necessity" from my PCP.  I went in for a physical and she wrote on a 'script that I was iron deficient and starting supplements but other than that, I was healthy enough for surgery.  Janese at Dr. Pomp's office called me today and was like "What the hell is this sh*t?" - not even close to what they need. 

I called my PCP's office and explained what I needed.  Explained that it has to go along the lines of "Janine P has been a patient of mine for X years and has always struggled with a weight problem, has tried X number of diets, blah blah blah".  Receptionist said she'd call me back after talking to my PCP. 

Receptionist called me back and said that my PCP said "No" to the letter.  That I haven't given my PCP enough "proof" that I've tried to lose weight and that usually, a 6 month diet is necessary before a letter of necessity is given out. 

My insurance doesn't need a 6 month diet.  Why won't she give me this damn letter?

I have a friggin' lap-band - how much more "trying" do I have to do?  I lost 100 pounds with the damn thing (and as my ticker shows, I've gained some back) - What more do I have to show to prove that I've tried?

I don't know what to do.  I just started crying out of frustration at the receptionist (that's what I do - I don't get angry or aggressive; I cry.) 

I put a call into my previous bariatric surgeon and asked if I could get a letter of necessity from them, but I'm doubting they'll do it because my previous bariatric surgeon doesn't like DS at all. 

Did anyone go through this?  Can you point me in the right direction?  Dr. Pomp says I need the letter, Insurance says, I don't need a 6 month diet, my PCP says I need a 6 month diet.  I'm lost.

Could you get your medical records & have your surgeon look over them & have him write the LOMN? If not, maybe another PCP could look at your records & write it? You could ask your surgeon's office which Dr.'s refer patients to them often.

I think Dr. Pomp specifically needs the letter from a doctor that's known me for an extended period of time, so the letter coming from him, or a doctor that I've known for a few months isn't going to cut it.

My previous bariatric surgeon, Dr. Mehta, I've known since October of 2006.  If I can get letter out of her, that would be awesome.

When I had my lap-band, insurance companies weren't this "strict" and I didn't need this letter.  Why I need it now is beyond me...

*Update*  my PCP wants to talk to Dr. Pomp's office on Tuesday of next week.  I'm a little scared that my PCP is going to direct Dr. Pomp's office to avoid me like the plague... I'm just being paranoid though.

Do what I did... it probably the revision.... they are harder on them ins wise !!!

Whom ever you have seen consistently for several months, ask for copies of all visits. ..
your previous wlsurgeon,  GYN, ect,
if you have not continued to loose. he can write a letter that you had a failure to loose and need a revision.
Also if you had a letter that was done for the first surgery that was submitted stating you had a medical necessity, that sometimes can be submitted.

When  I did mine, they were more interested in previous criteria having been met, and something showing I was followed by a wl office, and no loss of weight, So that is what I sent in. Previous I had submitted GYN records of no weight loss for 5 years.

Does not have to be a PCP can be a GYN, WLS as long as it is a DR....writing letter that you should have it..

Good luck, and keep plugging!!  you might have to appeal too!!  But do it!

That's the problem - I haven't seen ANYONE consistantly for the past few months.  When things are wrong with me, I just deal with it; I'm not a doctor-visit type of gal.  I take advil and clench my teeth if I'm in pain.  Plus, my PCP doesn't even weigh me.  I had a physical on Tuesday night, and she didn't weigh me.

OK, I don't get your PCP not wanting to do this...  Did she authorize your referral to visit the surgeon?  If so, then she has already agreed that there is medical necessity. 

My insurance req. a letter from the surgeon, not my PCP. 

Good luck,

Aimee :)

No.  I picked Dr. Pomp myself.  I pursued WLS myself.  I'm 316 pounds - It didn't take massive amounts of pondering to figure out that I'm in need of weight loss surgery.

I don't get it either.  I've been fat ever since I started going to her, like 10 years ago. 

Your PCP sounds like a dork, sorry to say. My insurance did require the 6 month diet (although I got it done in 3 due to mechanical failure) and my PCP was willing to work with me all the way. She's phenomenal.

How the hell could your PCP say you're not trying if you have a lap band? Like me, you kept off a significant amount of weight. Maybe she's anti-surgery?

Good luck and hang in there!

Girl, I don't get it at all.  My PCP is a doll - so sweet, understands my frustration, and isn't anti-surgery; she was supportive of my lap-band. 

I have no clue what the issue is.  I really don't. 

that sounds awfully strange. Hopefully after talking to Dr. Pomp, you'll get the proper letter. My PCP wrote a good one, I was very happy.