 Read my "letter of medical necc" and tell me if I have a chance | |
Hi, here is the letter my PCP sent to Cigna. Do you think it is compelling/informational/persuasive enough to get the sugery covered? Is this close to what your letter looked like?
I am writing this letter of medical necessity on behalf of my patient, xxxxx. I am requesting insurance coverage for a laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components) and the CPT code is 43770. She has tried numerous diets and weight loss programs for the last 15 years. She is successful for a few months but her weight loss was 5% or less and short-lived. She has gained the weight back and more time and time again. She had a resting metabolic rate done in our office in August 2005 and had consequently followed the caloric recommendations with daily exercise and gained 5lbs over the next six months. Her BMI was 39.5 in February 2006.
Here are some of her weight loss attempts:
In the last 5 years she has tried the following diets (with exercise):
Weight Watchers (multiple attempts)
South Beach
Low-carb (Atkins)
Low-calorie, low-fat calorie counting.
EXERCISE:
She also has been seeing a personal trainer for 9 months.
She was on a diet of 1700 calories a day for 4 months.
In all of these attempts her weight loss was 5% or less and short-lived.
Weight related conditions:
Swelling of feet and legs, knee pain, achy joints, and pain in arches and heels if she is on her feet for any length of time. She has low back pain after only 15 or 20 minutes of walking or standing. She has tried better shoes and supports but to no avail.
She has been diagnosed with depression and anxiety. Her medications include Zoloft and Wellbutrin. She suffers emotionally from being overweight.
Family history in her words:
3 of my 4 grandparents died of heart disease. My mother, father and brother are obese. My uncle is taking medication for high blood pressure and high cholesterol.
I will enclose her recent office visits and tests that have been performed since she has been under my care.
Please fax or email me with decision of patient's coverage for surgery. If I can provide any other information please let me know.
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