Helloooo...

[Guest guest]

Yesterday I requested help regarding a letter from my from my PCP for my

insurance co. I remember reading where some post-ops wrote the letter

for hte PCP. Will someone please help me????

Tj

~I didn't fight my way to the top of the food chain to be a vegetarian~

Direct Email: ziff_@...

[Guest guest]

TJ,

I took the time to do a message search on the DS egroups site, using

" letter " in the search window, and came up with the attached letter by

, but I believe the original was by Heidi. I tried finding that,

but don't have the time. I would suggest emailing Heidi privately and

asking her for a copy!

Hope this helps

Robin F (copy of letter follows)

-------------------------------------------------------------------------

Dear Heidi, today I called my ins co as instructed to see if I had

been

approved. They put me on hold and said that although they had

received the

LOMN from Dr., they had forwarded directly to the appeals

department. I

asked if there was a problem, was I appealing already? THey said no,

it was

just the way they handled " nonroutine requests " . She also said that

they had

mailed the lomn to the other department, and that it had not yet been

received, so if I wanted to fax a copy to them that would be fine. At

that

point I asked if I should mail just the LOMN,, or if it would be

helpful for

me to include some other information that I had gathered, and she said

SEND

EVERYTHING.

I rushed home from work and started looking through the stuff I've

been

collecting. I'm not real thrilled with my LOMN, so I decided to write

a

personal appeal. My letter follows. I am sure that it will look VERY

familiar to you. THANK YOU so much for the wonderful letter that you

posted

on your web site. I stole a lot of it outright, and modified the

rest. I

could not have written this letter without you. Everyone who has read

it

says they can't possibly turn me down - the letter turned me from a

statistic

into a person. I'll let you know when they approve me - please note I

did not

say if, I said when. THANK YOU THANK YOU THANK YOU -

our letter folllows:

October 13, 2000

Dear Prudential Health Care:

My name is and I am a 49-year-old woman, married with

two

children. Next June is a really big month for me. I will be

celebrating my

50th Birthday, my 25th wedding anniversary and my older son's high

school

graduation. While reflecting on these important dates I realized that

my

father had his first heart attack when he was only 4 years older than

I am

now - and he was not obese.

I am very obese. I do not have an " eating disorder " , I don't binge, I

have

slowly gained weight over the past 25 years. Every time I diet, I

regain the

lost weight plus a little more. I will include a diet history with

this

letter. I now weight 301 lbs, and the quality of my life is

suffering. I

know that if I want to live to meet my grandchildren, and enjoy the

retirement that my husband and I are working so hard for, I need to

lose this

excess weight. I also know that dieting alone is not going do it.

I have been in good health in spite of my weight, but I am beginning

to see

the effect of 150 extra pounds. I am short of breath - and cannot

even climb

one flight of stairs without resting. I am beginning to notice that

my feet

swell. I suffer from stress incontinence, back pain, joint pain and

varicose

veins. Last year I fractured my ankle while walking across the

street.

I have been doing research on obesity and I learned that I have a

disease. I

learned that there are three stages of obesity: obese, morbidly obese,

and

super morbidly obese. People with a Body Mass Index of greater than

50 fall

into that last category. My BMI is 51. I know that heart disease,

cancer,

and diabetes are inevitable. It is just a matter of time. I have a

strong

family history of all of those diseases. My risk of heart failure is

208%

greater than a person with a normal BMI. My obesity is a direct

threat to my

life.

I also discovered that the NIH has recognized that only 2% of people

who

attempt to lose weight will lose it and keep it off for 5 years. The

NIH has

published a report stating that surgery is the only permanent solution

to

keep weight off and avoid death and disease associated with obesity.

The surgery that I am requesting is medically necessary to allow me to

lose

weight permanently, and to correct the co-morbidities that are

affecting my

health and my life. Without this one surgery I am looking at a future

of

many: breast reduction to eliminate my chronic back pain, knee

replacements,

bladder surgery to repair my problem with incontinence, and possibly

many

others. I have already had one operation as a result of my obesity; I

had my

gall bladder removed. I don't like surgery, I don't want surgery, but

if I

had to choose one surgery or many I would choose the one, lifesaving

procedure that I am asking you to approve.

My research has led me to the BPD/DS. I firmly believe that this is

the

correct procedure for me. Statistics demonstrate that after this

procedure

patients lose 85% of their excess weight, and keep it off. It allows

an

essentially normal lifestyle post operatively, allowing me to eat

small, but

normal meals. Because it preserves the pyloric valve, the dumping

syndrome

associated with other types of weight loss surgery is avoided. The

fact that

I can have this operation done locally and laproscopically are added

bonuses.

I understand that by using Doctor I will be going out of

network, but

he is willing to work with me as I raise the $4,000.00 that I will be

responsible for. I will work overtime to raise that money because I

want to

live a long and productive life.

Please approve this surgery. I want to see the wonderful men my sons

are

going to become.

Sincerely,