SUGGESTIONS,,,,,,,,,,,,,,,,, ANYONE???
Today I went and saw my PCP. for my final follow up appointment before insurance approval. One of the things that I have to get from him for the insurance company is a letter recommending surgery as a means to gain control of my obesity. (I’m sure you all under stand). Anyway, when I asked him for the letter, his response was, “Write one, I will go over it have it typed up a sign it.” Because he doesn’t have time to write such letters.
WHAT???????????????????????????????????????????
Now I have called my surgeons office and told them what he wanted me to do and asked if this was okay. They said “NOT REALLY” but, they have had people in the same situation and it worked out just fine………..
Now I guess that should have been enough. But, I don’t know what to say… How do I go about this?? Do I write a letter from him or do I write a letter from me and just ask him to endorse it? I don’t know anything about writing a DOCTORS recommendation. Isn’t that kind of dishonest????
Has anyone had to do this for their approval???? How did you go about it.. I’m really open to suggestions. I just don’t know where to begin.
THE BIG PROBLEM IS THAT I NEED TO DO THIS NOW!!!!!
Month/Date/Year
RE: Patient Name
Group # Plan #
Member ID#
Request for Pre-Approval for Gastric Bypass Surgery
To Whom It May Concern:
______________has been under my care for the past _______years. She is __ years old, stands ____ tall and weighs ___ pounds. She has a history of childhood and adult obesity with a current BMI of ___. The Body Mass Index is calculated by dividing a person’s weight in kilograms by their height in meters squared. When a man’s BMI is over 27.8, or a woman’s exceeds 27.3, that person is considered obese. The degree of obesity associated with a particular BMI ranges from mild obesity at a BMI near 27, moderate obesity at a BMI between 27-30, severe obesity at 30-35, to morbidly obese for patients with a BMI of 40 or greater.
____________’s family health history is that both parents are diabetics with high blood pressure, her sister is diabetic, and her grandparents on both sides had a history of heart conditions, diabetes and high blood pressure. ___________’s weight condition will undoubtedly cause her significant health problems, some of which will only get worse as time goes on. One of her current health problems is ___________, and weight loss is significantly imperative for aid in the longevity of her success with the treatment and her remission from this disease.
_____________ knows the health risks 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:
- Nutri-System (1990) for 5 months with loss of __ lbs. (starting at ___ lbs., ending at ___ lbs.)
- Fastines (diet pills) and Lasix (1990) for 2 months with loss of __ lbs. (starting at ___ lbs, ending at ___ lbs.)
- The Cabbage Diet (1991) for 3 weeks with loss of _ lbs.
- Fastines and Lasix (1993) for 3 months with loss of __ lbs. (starting at ___ lbs., ending at ___ lbs.)
- Fastines and Lasix (1996) for 4 months with loss of __ lbs. (starting at ___ lbs., ending at ___ lbs. In addition, _________was a member at YMCA for almost a 2-year period, on a daily exercise program to assist in the weight loss.
- Low-Carb Diet (1998) for 2 months with loss of __ lbs., starting at ___lbs., ending at ___)
- Slim Fast Diet (2001) for 3 months with loss of __ lbs. (starting at ___ lbs., ending at ___lbs.
- Mild diet with a reduced calorie intake (1999-2000) for a 12-month period while under treatment for _________ (starting at ___ lbs., ending at ___lbs.)
__ lbs. is the most weight that __________has ever lost at one time in the past 13 years. That was done through diet pills, change of eating habits and exercise. As you can see, it has had no long-term success. It is my recommendation that __________not continue taking diet pills, especially since diagnosed with _______. I feel the side effects could be more damaging to her and only cause additional health concerns in the future.
_________has been over ___ lbs. For the last __ years and up until __ years ago she has been extremely lucky not to have had any major health concerns. _______’s attempts at losing weight with subsequent regaining of weight have only proven to cause her more health concerns. It is time for a permanent resolution to eliminate future health concerns related to morbid obesity.
For the past __ years _________has been under the care of ________ for treatment of her ________, which in itself is important for her weight loss. From the known success rate of gastric bypass surgery and health benefits involved, I feel this would be the BEST solution for PERMANENT weight loss and eliminating future health concerns due to morbid obesity, as well serving to keep current health conditions from worsening. Obesity has been shown to directly increase health care costs. In an article in the March 9, 1998 issue of the Archives of Internal Medicine, 118 members of the Kaiser Permenente Medical Care Program were studied to determine the association between body fatness and health care costs. The results showed that patients with BMIs greater than 30 had a 2.4 times greater risk for increased inpatient and outpatient costs than patients with BMIs under 30.
Americans spend an additional $33 billion annually on weight-reduction products and services, including diet foods, products and programs. Most of these expenditures, as evidenced in this case, are not effective. Rather, it can be expected that she will continue to gain weight and the costs of co-morbid conditions, including the ones she already has and/or she will surely acquire as time goes on, will far outweigh the costs of gastric bypass surgery that we are asking you to please approve for this lady.
I trust this information will aid you in understanding the true severity of _________’s case and in facilitating the proper assessment. Please feel free to contact me if I can answer any questions or clarify any issues you might have.
Sincerely,
(Physician’s name)
http://www.obesityaction.org/advocacytools/insurance/OAC%20Insurance%20Piece.pdf
it'll give you enough.
Bascis are BMI, Weight history, dieting history, diagnosis of any comorbidities, general health. etc.
let me know if you need more help.
Port repaired 6/16/2010 weight that day 270
