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I typed out my letter and took it to my Dr, had her copy it on their letterhead and sign it. I scheduled an appt specifically for that.. figured since I paid the copay.. she was getting paid to do it. That's what worked for me.. Good Luck.

DATE

To whom it may concern;

I am writing this letter on behalf of my patient XXXXXX DOB XX/XX/XXXX. XXXXXXXX is XXXX tall and weighs XXXXlbs. and a BMI of XX.X with a diagnosis of morbid obesity (278.01). XXXXX has been excessively overweight for most of her adolescent and all of her adult life and having attempted and been unsuccessful at many different methods of weight loss, would certainly benefit from some sort of bariatric surgery.

In addition to morbid obesity, XXXXX also suffers from the following co-morbid conditions, sleep Apnea (780.57), GERD (530.81), Shortness of breath (786.05), Stress Incontinence (625.6), Back Pain (724.2), Knee Pain (716.98), and has a positive family history of obesity, hypertension, diabetes and hypercholesterolemia. (These are just a few that may qualify you)

XXXXX has tried many method of weight loss including a physician administered diet and diet pills with an approximate weight loss of XXlbs only having to gain the weight back plus more. (Weight Watchers, Jenny Craig etc..)

XXXX is limited due to her co morbidities in the ability to exercise however she is currently a member of XXX fitness club with a weight loss of 0lbs.

I feel that XXXXX would benefit greatly from the Lap Band Procedure (43770) as a tool to help lose the excess weight and lessen the co-morbidities and regain a more healthful life.

Sincerely,

Edited by Maya314
:D

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thanks Maya....this Sounds Great

as You Can See I'm Still Logged On Here Trying To Find Help...and You Came Through...thanks A Heap...i'll Probably Be Up For A While (as Usually I Am...don't sleep Without Meds..i'll Add That Too) And Plan On Taking It To Her Office Tomorrow....

will Let You Know How It Turns Out....

oxox

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I never needed a letter from my PCP doctor. He wrote the first thing on a prescription pad, sending me to see the surgeon, (I didn't need a referal either) and then I faxed over the requirements to his office that the surgeons office required and that was it.

I don't get why the doctor gets an attitude when they were working with you through the procedure in the first place. Unbelievable.

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I do understand that docs are very busy and stressed and letter writing and jumping through insurance hoops can be a pain. But GEEZ - didn't they know that going into the profession? Isn't their staff competant enough to have these types of letters ready to be tweaked and signed? To me this is just like writing you a prescription! Your RX is medically necessary just as your WLS is, or your surgeon wouldn't be doing it. Perhaps writing a letter to the insurance company to complain about this might also make you feel better. Is your doc in private practic, or is this a partnership. Do all of the partner's have the same policy? Hang in there, you will find a way around this, and look back on it later as just a bump in the road!

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shorty, stay strong and be encouraged. Over 2 years ago my pcp did similar to yours. She sabotaged my attempt at surgery during my weight loss trial for insurance. 3 months in, I had lost 22lbs (most of it Water weight, from cutting out soda etc...) and she decided if I stuck to the diet I could lose the weight, no surgery needed. She told me she wouldn't recommend the surgery, and blew my hopes out of the water.

I got depressed, gain back all the weight I'd lost plus some more, and figured I was screwed. Then I changed pcp's, and my surgery is now in June.

Don't waste time on depression or feeling sorry or upset. Simply switch pcp's. Get all your documentation sent over to your new pcp, and have them write the letter. The letter from the new pcp and included documentation will prove you've done the weight loss trial period, and completed all you need to do. The insurance should still accept it, mine did. Good luck!

-Brian

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She sounds so mean! I would try your OB/GYN. Mine said if I had any problems with my PCP he would do whatever I needed. Good luck!

I told my PCP they might request a letter from him, but when I went to my Ob/Gyn, she was so excited about me having surgery that she actually asked me what I needed my record to say should they request it! So we went over a few things and when I went back to my surgeon's office, I told them by all means, to request my record from her!

I can't believe your PCP is so into herself! Glad you are changing and hope you can get over the hurdle. Good luck!

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I typed out my letter and took it to my Dr, had her copy it on their letterhead and sign it. I scheduled an appt specifically for that.. figured since I paid the copay.. she was getting paid to do it. That's what worked for me.. Good Luck.

What ever happened with this?

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Hey All,

I have been talking with my ins. co. (Horizon BC/BSnj)...and letting them know what is goingn on...they have instructed me to have the surgeon's office to submit my case as is...and they will have the Bariatric Nurse take over my case...unfortunately...my co-ordinator at the surgeons office was on vacation last week and her assistant seem in a fog as to how to put it together.....I will be on the case first thing on Monday....will keep you abreast on how things progress..

Shorty184

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Goodmornig All,

So let the games begin.....I call the surgeons's office this morning (10:15) and was ,you guessed it, dumped right into voice mail...I'm beggining to get the feeling that maybe I need to reqroup with a new team and start all over again.....this drs. office does not rank in the top on answering and returning calls...as if I need this coupled with the issues with my PCP....well we"ll see...I be back

Shorty

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Goodmornig All,

So let the games begin.....I call the surgeons's office this morning (10:15) and was ,you guessed it, dumped right into voice mail...I'm beggining to get the feeling that maybe I need to reqroup with a new team and start all over again.....this drs. office does not rank in the top on answering and returning calls...as if I need this coupled with the issues with my PCP....well we"ll see...I be back

Shorty

You are so patient, I would jump in my car with a crazed look on my face and head straight in to deal with these "nice people" in person.....grrrrr

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Mischiev...you make me laugh.....and I've been in the dumps all weekend...just the picture of it made me do a big one out loud....THANKS

Well I did get a call back about 1:OOPM..and as suspected my case had not been submitted....but I was assured that it would be by day's end and defintely by tomorrow morning....so I will start the web stalking of my Ins Co...my co-ordinator at the surgeons office say the turn-around is usually about 1 week...sooooooooooI'll keep you guys informed.....as I turn on the coffee maker..it's gonna be a long week...

Shorty

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Good Luck, Shorty! I just read about your PCP, she sux! I think that you should stay on top of your team, too, by calling them again tomorrow to ask if your claim has been submitted yet. Just keep on top of it.

I'm pulling for you.

Kat

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