bunnytails
I have been over weight for my entire adult life. I have struggled with my weight ever since I can remember. I first started caring about my weight and how I looked when I was 18 years old. My mother was obese as well. I can remember when she would go to the Doctors office and get prescription pills. She would give me her diet pills to help me loose weight. Request for Pre-approval for Gastric Bypass (Diagnosis Code 278.01, Procedure code 43847).
To Whom It May Concern:
Please accept this letter as a formal request for your pre-approval for gastric bypass surgery for my patient, Neicemarie. She has been a patient of mine for over 12years and has continuously struggled to lose weight.
Niece is 5 ft 7 inches tall and weighs 246 pounds. Her body mass index is 39. she, is classified as being severely obese. (Code 278.01) I ask for your pre-approval for this surgery. I will detail the issues of medical necessity.
Niece is having significant adverse symptoms from her obesity. She has difficulty standing and in doing any kind of exercise, even walking more than a short distance. She has difficulty performing any daily activities and in participating with her family in recreational activities.
She suffers from stress incontinence and has to wear protective pads at all times. A large heavy abdomen, and relaxation of the pelvic muscles, especially associated with the effects of her hysterectomy, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with coughing, sneezing, or laughing. This condition is strongly associated with being overweight, and is usually relieved by weight loss.
Niece also has sleep apnea. Sleep apnea — the stoppage of breathing during sleep — is common in the clinically severe obese. The health effects of this condition may be severe. It has been estimated that up to 50 percent of sleep apnea patients have high blood pressure. Risk for heart attack and stroke also increase in those with sleep apnea. People with sleep apnea often feel very sleepy during the day and their concentration and daytime performance suffers. The consequences include depression, irritability, sexual dysfunction, learning and memory difficulties. This condition has a high mortality rate, and is a life-threatening problem. People are usually cured of sleep apnea by this surgery and the permanent weight loss it brings.
Niece has been diagnosed with high blood pressure. Essential hypertension, the progressive elevation of blood pressure, is much more common in obese persons, and leads to development of heart disease, and damage to the blood vessels throughout the body, causing susceptibility to strokes, kidney damage, and hardening of the arteries. If hypertension is not under control, many complications can occur as a direct result of continued high blood pressure. Sixty percent of hypertensive people are obese. The weight loss attained by gastric bypass surgery will cure hypertension. She is currently on blood pressure medication to control her blood pressure.
Niece Also has hypercholesterolemia (high cholesterol). When there is too much cholesterol in one's blood, the excess can become trapped in the walls of one's arteries. By building up there, the cholesterol helps to cause hardening of the arteries or atherosclerosis. And atherosclerosis causes most heart attacks. How? The cholesterol buildup narrows the arteries that supply blood to the heart, slowing or even blocking the flow of blood to the heart. So, the heart gets less oxygen than it needs. This weakens the heart muscle, and chest pain (angina) may occur. If a blood clot forms in the narrowed artery, a heart attack (myocardial infarction) or even death can result.
Niece also suffers with Arthritis. This a major comorbid condition that she has. One of the nearly intolerable problems is the constant pain of the weight-bearing joints. An increase in body weight adds trauma to weight bearing joints and excess body weight is a major predictor of osteoarthritis. This is a mechanical problem and not a metabolic one. The hips, knees, ankles and feet have to bear most of the weight of the body. These joints tend to wear out more quickly, or to develop degenerative arthritis much earlier and more frequently, than in the normal-weighted person. Eventually, joint replacement surgery may be needed to relieve the severe pain. She also suffers from lower back pain due to degenerative disk.
She suffers from venous stasis disease. The veins of the lower legs carry blood back to the heart, and they are equipped with an elaborate system of delicate one-way valves, to allow them to carry blood “uphill.” The pressure of a large abdomen may increase the load on these valves, eventually causing damage or destruction. The blood pressure in the lower legs then increases, causing swelling, thickening of the skin, and sometimes ulceration of the skin. Weight loss after gastric bypass can relieve venous stasis disease.
Because of her weight, she is depressed. Seriously overweight persons face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. It is no wonder that anxiety and depression might accompany years of suffering from the effects of a genetic condition — one which skinny people all believe should be controlled easily by will power
Coronary artery disease is another problem caused by clinically severe obesity. Severely obese persons are approximately 6 times as likely to develop heart disease as those who are normal-weighted. Coronary disease is predisposed-disposed by increased levels of blood fats, and the metabolic effects of obesity. Increased load on the heart leads to early development of congestive heart failure. Severely obese persons are more likely to suffer sudden death, in many cases due to cardiac rhythm disturbances. Coronary artery disease runs in her family. Her father has Coronary artery disease and has suffered 2 heart attacks. Her grandfather had died from a massive heart attack (Coronary Heart Disease.)
She becomes short of breath on any exertion. She cannot climb a flight of stairs without stopping, and has a very difficult time performing the ordinary day-to-day duties of living, she was once physically active, walking/running and enjoying gardening, but at this time she is unable to perform any recreational activity, and feels depressed because she cannot control or lose the weight. Obese persons find that exercise causes them to be out of breath very quickly. The lungs are decreased in size, and the chest wall is very heavy and difficult to lift. At the same time, the demand for oxygen is greater with any physical activity. This condition prevents normal physical activities and exercise often interferes with usual daily activities, such as shopping, yard-work or stair climbing, and can be completely disabling. Losing weight will cure respiratory problems.
Niece has also been diagnosed with gallbladder disease & peptic ulcer. She had a cholecystectomy on Niece has had a complete hysterectomy removing ovaries, cervix and uterus. She was diagnosed with complex endometrial hyperplasia without atypia. Her surgeon was Dr. Richard Boothby and assisted by Dr. Norma Waite. Her surgery was done She has made many attempts to lose weight, including:
I have referred Mrs. ////////////// to U.S Bariatric, Dr. Keith Kim at Florida Hospital Celebration Health. Niece has contacted his office, attended his informational seminar and a support group meeting, and agrees with me that this is the only way to correct this situation. Should you have any questions regarding this recommendation, please call me at ADD MUSIC VIDEO HERE
Music Video:http://videzonn.com/videos/s/shania_twain/come_on_over.html" target='_blank'>COME ON OVER (by Shania Twain)
May 11,2007
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Oct 2004 after many years of trying to loose weight and yoyo dieting my entire life I made the decision to have the surgery. It has been a battle trying to get the insurance to cover my surgery. I went through all the test and hoops to get final approval only to be told DENIED. Well I gave up on the surgery for now until I can get my financing together to have the surgery.
Well I'm starting over 3years later. Oct/2006 I started the process over again. Im getting so depressed with my weight issues. I can't stand it any longer. Im ready to battle with the big beast (BC/BS INSURANCE)
on My Birthday while At work I received a phone call from US BARIATRIC and spoke to Amanda. She said Happy Birthday and that she had some good news. My insurance company covers WLS with stipulations. I would need a letter of medical necessity , documentation of failed attempts at weight loss, Psychological evaluation and nutritional Consultation with a nutritionist experienced with Bariatric surgery.
Well needless to say I jumped up and down and I was the happiest camper while celebrating my 49th birthday. I figured I would enter 50 being healthy and the best shape ever. I would have a year to get there. Well I was doing the happy dance.
I made an appointment with my PCP and put together letter of Necessity. I omitted my name and address from the letter for security reason.
April 2007 submitted letter for Medical Necessity
Anthem Blue Cross/Blue Shield
Sincerely,
Had my appointment with nutritinalist, appointment went well , she went over the do's & don't. Advised me to start now to practice eating slowing chewing foods at least 20 times before swallowing. She also gave me a diet to follow prior to surgery. I need to loose at least 10% before surgery. She was pleasant to speak with, her name was Sherri Flynt, MPH, RD center of nutritional Excellence.
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