Sample Letter Of Recommendation For Weight Loss Surgery

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Matthew fourman md 5012 talmadge road suite 200 toledo oh 43623 phone. See what makes a quality letter of medical necessity.

This condition has a high mortality rate and is a life threatening problem.

Sample letter of recommendation for weight loss surgery. Please evaluate my patient as a candidate for weight loss surgery. If considered an appropriate candidate. For your convenience we have provided this template that you may use when creating your letter.

My height and weight are height weight and my bmi is bmi. I would be happy to see the patient again prior to surgery for medical clearance. Sample mcsampleton this is a sample letter for your reference only.

I believe the patient is a good candidate for surgery and would benefit from significant weight loss. Your primary care physician can write the letter assuming you are morbidly obese. As statistics show and as medical doctors you must be aware that diet and exercise help but as a long term resolution to permanent weight loss only 5 percent of people succeed.

Please fax to georgia regents weight loss center at 706 721 7524 or mail to. I am appealing your decision for denying my medically needed weight loss surgery. The letter of medical necessity is the first required step before weight loss surgery.

This is a sample only. Sample letter of medical necessity. The remainder of the physical exam is unremarkable.

Provided to you by allergan note. Georgia regents weight loss center 1120 15th street bi4074a augusta ga 30912 sample letter of medical necessity give this to your primary care physician for himher to fill out. I have sleep disturbances and one doctor suggests a sleep study for sleep apnea.

Mercy weight management center dr. The weight loss would help with sleep disturbances and cure sleep apnea. 419 407 3993 we are in need of a letter of medical necessity for.

Sustained weight loss and would therefore benefit from consideration for weight loss surgery in order to improve their overall health quality of life and to minimize their risk of obesity related comorbidities. Name of practice name of physician md insert addresscontact information date. People are usually cured of sleep apnea by this surgery and the permanent weight loss it brings.

Payers vary on their requirement for letters of medical necessity and it may be necessary to submit with copies of medical. Letters of medical necessity must be customized for each patient as supported by documentation in the patients medical records. This surgery is reconstructive following massive weight loss per the american society of plastic surgeons and the american medical association.

Per customer service representatives with ibc there are no exclusions or preexisting clauses on my policy as long as procedures are medically necessary or will correct functional impairment.