A Letter of Medical Necessity and weight-loss history are necessary to obtain prior authorization for obesity surgery in most cases. A Letter of Medical Necessity states why significant weight loss is medically necessary for a patient and usually includes the following information:
Patient’s Weight and BMI
BMI should be more than 40 or at least 30 with associated medical problems
List of medical problems associated with obesity
such as type 2 diabetes, sleep apnea, hypertension, etc.
Number of years patient has been overweight
Usually should be at least five or more
Number of types of failed weight-loss programs attempted in the past
If you can document all your weight-loss attempts (self-controlled or medically supervised) and their results, you often can substantially increase your chances of getting insurance coverage for the LAP-BAND procedure. You should include any commercial diets or medical records of your weight-loss efforts.
We will help you with this Letter or Medical Necessity and will form it for you so as to best increase your chances of successful submisison. Please help us though by gathering as much of the information before we see you for your initial consultation. See the Forms page for helpful ways of organizing this information.
And you can call 1-800-LAP-BAND (527-2263) and LAP-BAND customer service will verify your benefits for you. Just be sure to mention Dr. Sidney Rohrscheib’s name!