I need approval advice please

I didn't read everyone's response (lack of time right now) but do have experience with this.  I ended up not being able to see my regular dr because he left the practice (saw him for 16 years).  I had seen a few other docs in the clinic over the years, but ended up seeing the NP whom I had never seen before.  She looked through my medical record, spoke with me and wrote an amazing letter.

Is there someone else within the practice that you have seen in the past, or who you would feel comfortable seeing?  ANY doctor who can review your records should be able to fulfill this requirement.  Good luck!

Thank you for the suggestion and I might have to resort to that method, but I'm not sure how effective it would be, considering I won't have a "history" with another doctor.

But I'll do whatever I gotta do...

If you have a good relationship with your pcp - and it sounds like you do, minus this particular issue - write the letter yourself and then have her sign it.

It is possible that she doesn't want to take the time to figure out what needs to be in it and write it out.  If you do that for her, all she has to do is read it and sign it.  Even better if you can put in on a flash drive so she can print it on her letter head, but probably not necessary.  Just make sure you detail what your issues are, what you have done to address them, the steps you've taken, and your failure to lose the weight.  Be specific, clear, and concise.

I know there are some copies of letters for medical necessity that peeps on the board have written - maybe make post asking for them or do a google search?  I don't have any bookmarked or I would include them here, sorry.

Good luck!!

Thank you Marci, but I did suggest that and the receptionist quickly said "No no no". 

My PCP's office wants to talk to Dr. Pomp's office.  I just hope my PCP doesn't try to talk Pomp out of seeing me.   Can they even do that?

I disagree -- you shoud NOT be listening to what the receptionist says!

YOU need to write the letter (in word, or plain text), and bring a printout and a cheap flashdrive or CD of the letter with you to an appointment that you schedule RIGHT NOW.

You hand her the letter and tell her this is what you need, and will she provide it (or something very much like it) or not?  If not, you want to know why.  If she has questions about how hard you have worked your Lapband program, she should ASK you, not make assumptions.

The letter should be as short and to the point as possible.  It should be written from your doctor's point of view.  It should say how long you have been morbidly obese, when you had the lapband (which you qualifed for at the time), detail the problems you have had with it and that you have been (generally?) complaint with your lapband surgeon's instructions, to the extent possible.  It should state that despite your compliance, the lapband has not provided the results that were needed, should state facts supporting this (amount lost, amount regained, current weight), your current comorbidities that would be alleviated by weight loss and that revision surgery is therefore medically necessary. 

This is a PITA for your PCP -- do her work for her.  You may have to obtain a copy of your own medical records to find the details (date, weight, calculated BMI, comorbidity diagnoses) to establish these facts in the letter.  MANY of us have had to do this to get our surgery approved.

Oh god bless you Diana, I was hoping you'd respond.

Am I being too pushy to write the letter out myself and ask her to sign it? What if she doesn't agree with something?

I just don't want to ruin my relationship with my PCP over this, you know?

Should I try to persue the LOMN from my previous bariatric surgeon instead?

 

Yeah, let's guess the odds of you getting a proper LOMN from your previous bariatric surgeon:

"I put a piece of **** crapband in my patient, as despite her efforts to be compliant with the miserable lifestyle and restrictions required, it failed her.  It was all my fault."

THAT'S not going to happen.

It is not too pushy -- you call it a DRAFT and tell her you know she will review it carefully and edit as necessary, but that you have received advice about the elements needed in an LOMN, and have provided the factual information from your medical records to make it easier for her to prepare.

The only thing I would add to what has already been said is that the problem may be the receptionist not the doc--they are the "gatekeepers" you know!  So I agree with the suggestion of making an appointment with your letter already written and see the doc personally to argue your case.

Definitely call and make an appointment to see the doctor yourself.  It would be great if you could schedule for before she speaks with Dr. Pomp's office - that way you could tell her what it is you have been told needs to be included, hand her the draft you've made to assist her and save her some time, and see for yourself how she seems to be reacting.  I'm thinking this way when she speaks with Dr. Pomp, she will see that you are not asking for something that's not necessary and that the draft you have provided accurately reflects the required criteria. 

Do NOT let the receptionist stop you.  I'd be willing to bet that she has decided on her own that this is something the doctor doesn't need to be bothered with and either hasn't even spoken with her OR the message she relayed isn't what you said at all.  I had a similar situation with my own PCP early on in my process.  I was told by my surgeon's office that one of the requirements of my insurance company was that I needed to have tried a pharmacological approach as well.  Long story short, although I had requested a call from my doctor, what I received was a return call from the receptionist stating that my doctor had said that she was not going to get involved with this and that my surgeon should be taking care of this.  I was flabbergasted for a day until the realization dawned on me that this was the RECEPTIONIST'S view and not my PCP's view of the matter.  So I called back and told the receptionist in no uncertain terms that she had two choices - give the doctor the message to call me back or schedule me an appointment.  Within two hours my PCP called me back.  She obviously hadn't heard anything about this previously and she immediately phoned the head of Reviews at my insurance company and told him in no uncertain terms that she would not allow me to take any of the commonly used pharmaceuticals due to my co-morbids.  He immediately faxed a letter to her stating that he would waive this requirement for me.  

So it could be your PCP, like mine, is just being wrongly protected by her staff.  Meet with her and give her the benefit of the doubt.  :) 

Sorry this got so long! 

Oh god no, Vivi - it was helpful, not long. 

I won't have time to get in before she talks to Dr. Pomp, because she wants to do that on Tuesday and there's no way they can get me in before that. 

Maybe she just wants to find out what Dr. Pomp needs? 

Either way, I'm going to put something together for just in case.

*sigh*

This is so stressful...