Need help- letter from pcp
For my 1st surgery I did not need to have a letter of medical necessity from my pcp, she just wrote a script with medical release.
however for my revision they are asking for a letter from my pcp.
Does anyone have a sample letter of what their pcp wrote? my pcp is great and will write the letter, however they take forever to get things done in her office, so i asked her if i write a letter can her office use it and she sign it, she said they will do that.
Please any help you could give would be greatly appreciated.
my surgeons office gave me a list of stuff to include in the letter, however I am so not good at writing letters.
Here is the letter I ghostwrote for my doctor and she slapped on her letterhead and submitted. I was approved by Aetna. Hope this helps!
To Whom It May Concern:
I am writing with regard to the health of my patient, Nicolle X. She is only 37 years old and super-morbidly obese, with a weight of 344 and a BMI of 55.5. Bariatric surgery is medically necessary and appropriate for her to enjoy a healthy and long life.
The Lap DS Procedure
In particular, Nicolle is an excellent candidate for the laparoscopic duodenal switch procedure (DS), which facilitates substantial, long-term weight loss by moderate restrictive and moderate malabsorptive means. It does not have the negative side effects of other bariatric surgeries such as the Roux-en-Y gastric bypass, including weight regain, “dumping syndrome" and ulcers. The DS also enables a more-normal absorption of many essential nutrients, including protein, calcium, iron and vitamin B12 than other bariatric surgeries. The duodenal switch procedure has been in use for 20 years and is not an “investigational" procedure.
The DS achieves an average loss of 50 percent of excess body weight at six months and 90 percent at two years. The DS minimizes complications associated with older bariatric procedures and limits weight regain seen with other procedures. In fact, a number of my patients who suffer from the disease of morbid obesity have had this surgery and are doing very well—they have lost their excess weight and have kept it off. Many of their co-morbidities, such as sleep apnea and diabetes, have disappeared.
Nicolle’s Current Health
Nicolle has been my patient since January 2007. I am concerned about her deteriorating health. She suffers from the following co-morbidities associated with her super-morbid obesity:
· pulmonary embolisms
· obstructive sleep apnea (she now uses a CPAP machine at night)
· degenerative joint disease in her knees
· clinical depression, (she takes a SSRI anti-depressant)
· herniated and degenerated discs in her lower back
· infertility (she used intrauterine insemination for her two successful pregnancies)
· diabetic blood sugar levels (she also had gestational diabetes in 2006)
· tender umbilical hernia
Nicolle’s Weight-Loss and Fitness Efforts to Date
To try and achieve a healthy weight, Nicolle has worked with several medically-supervised and commercial weight loss programs including the Northwestern University Wellness Institute, Weigh****chers and Jenny Craig. She also has been active in several exercise regimens at health clubs and at home. Additionally, Nicolle has worked with behavioral psychologists who specialize in obesity in 2003 and again in 2006. She has lost modest amounts of weight, but has regained that weight and more.
Nicolle’s SSRI regimen (since 1997) and her fertility treatments and pregnancies have made weight loss drugs such as Meridia inappropriate for her use. Today, she has such a significant amount of weight to lose—nearly 200 pounds— that the weight loss drugs available today would not make a significant impact on her overall health.
Upon my recommendation, Nicolle has undertaken an exercise regimen to improve her overall fitness so that her proposed bariatric surgery and recovery will go smoothly. Since January, Nicolle has worked with a personal trainer two to three times a week and has established a fitness routine that she can continue to do the rest of her life. Her trainer has indicated that Nicolle is very compliant and has significantly improved her cardiovascular endurance and greatly increased her strength and flexibility.
Nicolle participated in Jenny Craig, a commercial weight loss program in July and August 2006. She ate their prepackaged meals, kept a food journal and met weekly with a weight loss consultant. They discussed her food intake and exercise and planned a new course of action for each week. After several weeks on the program, Nicolle complained of migraine headaches. I advised Nicolle to discontinue the program to see if the headaches were related to the program’s prepackaged food. Her headaches immediately disappeared.
In October, November, December of 2006 and January 2007, Nicolle was seen by a registered dietician at the Northwestern Memorial Wellness Institute in Chicago. She maintained food journals of what she ate and shared the results weekly with her dietician. Nicolle and her dietician routinely discussed food labels, the food groups, portion sizes, hydration, and the importance of eating at least six mini-meals a day.
In late 2006, Nicolle had a psychological evaluation by the Health Psychologist for the Northwestern Memorial Wellness Institute in Chicago. Nicolle was found to be an excellent candidate for bariatric surgery—well-informed about the potential risks and outcomes and determined to make the necessary lifestyle changes to be successful.
Nicolle and I have discussed the proposed bariatric surgery several times. She has done an impressive amount of resear*****luding meeting with several surgeons who perform the DS, Roux-en-Y, and Lap-Band procedures. She has attended support group meetings, interviewed several post-surgery individuals and has joined the www.ObesityHelp.com message board. Nicolle is aware that bariatric surgery is only a tool and that she will have to carefully monitor her food and vitamin intake and have a commitment to exercise for the rest of her life. Nicolle and I agree that the best option for her is the DS versus other bariatric surgeries.
Nicolle’s health will greatly improve if she loses a significant amount of weight. The DS is medically necessary and appropriate to help her get her body to a healthy weight. If there are any further questions in this matter, I will review written requests. Thank you.
I had the kick-butt duodenal switch (DS)!
HW: 344 lbs CW: 150 lbs
Type 2 diabetes and sleep apnea GONE!
Here is the one I wrote (with the helpful tips from this board) and had my PCP sign:
Request for Pre-approval for Duodenal Switch surgery
To Whom It May Concern:
Mrs. (Last Name) has been under the care of ( PA-C's name here) for the past 9 plus years. She is 37 years of age, stands 5’3" tall and weighs 226 lbs. She has a history of childhood and adult obesity with a current BMI of 40.6.
Mrs. (Last Name)’s weight condition has caused her significant health problems, some of which appear to be getting progressively worse as time goes on. Some of this patient’s current health problems aregastro esophageal reflux disease (GERD), urinary stress incontinence, leg, ankle and hip pain, depression, and edema. Family medical history is positive for obesity, hypertension, diabetes, heart disease, and hypercholesterolemia.
Mrs. (Last Name) knows the health risk associated with morbid obesity and has done her best at attempts to control her weight. In an effort to resolve her weight problem, she has undergone numerous weight loss treatment plans such as:
|Diet||Date||Duration||Start Wt.||Loss||End Wt.|
|Low Calorie||7/84||25 years off & on||175||+51||226|
|TOPS||7/84||5 years off & on||175||+85||260|
Mrs. (Last Name) has been under the care of this office for the past nine plus years and within that time we have monitored her success/failure on weight loss programs. She is seeking rectification from her failed RNY. Unfortunately, it is causing her great pain and has had no long-term success. She is currently planning a revision to the Duodenal Switch.
Mrs. (Last Name) has been over 200 lbs for the past 22 years, with the exception of 2 years following her 2002 RNY, and up until a few years ago has been extremely lucky not to of have any major health concerns. Mrs. (Last Name)’s attempt at losing and re-gaining weight has only proven to cause her more health concerns. Mrs. (Last Name) is a very active female. She works as a clerk in the warehouse at the telephone company, which demands many hours standing and walking. Mrs. (Last Name) is experiencing severe pain in her knees and hips as well as ankle and calf swelling and unable to take anti-inflammatory (NSAIDS) due to her current RNY pouch. I believe weight loss would help to eliminate these symptoms. Mrs. (Last Name) also has a family history of diabetes. Her obesity places her at greater risk for adult-onset obesity; as nearly 80% of patients with this disease are obese. It is time for a permanent resolution to eliminate future health concerns related to morbid obesity.
I trust this information will aide you in understanding the true severity of Mrs. (Last Name)'s case and in facilitating the proper assessment. Please feel free to contact me if I can answer or clarify any questions you might have.
Sincerely, (PCP's signature)
Hope this helps!!!!!
RNY 2/26/2002 DS 12/29/2011
HW 317 SW 263 BMI 45.1
SW 298 CW 192 BMI 32.9~60% EWL
LW 151 in 2003
Normal BMI 24.8 is my GOAL!!!
GBP (RNY) 2/26/02 298 lbs, TT 4/9/03 151 lbs, DS 12/29/11
HW 317 SW 263 BMI 45.1/CW 192 BMI 32.9/GW 145 ~ Normal BMI 24.8
**Revision Journey started 3/2009 Approved 12/12/11**
I am in support of my patient, "name", undergoing a weight loss surgical procedure. The patient understand the risks and benefits of weight loss surgery. The patient has reasonable expectations and I believe the patient will be compliant with all post-op surgical requirements. I understand the program is comprehensive with dedicated and specially trained staff. The patient is a low risk for intra-operative cardiac complications based on ACC/AHA guidelines.
Then my PCP listed my date of birth, height, weight, BMI, current medications, and medical conditions.
I hope this helps!
Note: My insurance did not require proof of failed diets or diet documentation.