A Personalized Letter For Insurance Approval [a template] - WLS Journey Community Forums [Weight Loss Surgery Support]

Insurance Talk The ever-dreaded 'I' -- We all have stories about insurance approvals, disapprovals, etc. Discuss insurance topics relevent to your WLS experience right here.
Thread Description:I decided to write a letter on my own behalf to my insurance company...

A Personalized Letter For Insurance Approval [a template]
A Personalized Letter For Insurance Approval [a template]
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Old 09-23-2009, 11:54 PM   Post #1 (permalink) • Tweet This Post  
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Surgery Type: Roux-en-Y Gastric Bypass
Default A Personalized Letter For Insurance Approval [a template] MsJacquiiC Started This Thread

I decided to write a letter on my own behalf to my insurance company in order to gain approval for my laparoscopic roux-en-y gastric bypass. It was not required, but it certainly could not hurt. So I insisted that the letter be included in all the other "official" paperwork my surgeon's office sent to the insurance company.

I thought I'd share it here in case anyone would need a template of sorts for their own personalized letter. Of course - the letter is a template... If you write a letter, it would be in your best interest to include specifics about your own situation.

I hope this helps someone, as I do believe it helped me get immediate approval from my insurance company.


The Following Text Is Quoted:
To Whom It May Concern,

I’m [YOUR NAME], a [YOUR AGE] old of [YOUR CITY/STATE]. I stand [YOUR HEIGHT] with my current weight fluxuating between [WEIGHT] pounds... I have had a history of childhood, adolescent and adult obesity. My current BMI is [YOUR BMI] which classifies me as [OBESE, MORBID OBESE or SUPER OBESE].

At [YOUR AGE] years old, my weight condition has not caused me any significant health problems except for high blood pressure, asthma, shortness of breath on exertion and some back & joint pain. I’ve thought about bariatric surgery over the years as a means to get my weight under control. In fact - After attending a few seminars, support groups, dietician classes and online communities for weight loss surgery (WLS), I’m quite sure WLS is the best option for me to get my weight to a healthy level and under control. I’m interested in having the [THE SURGERY YOU WANT] actually - and I’m most sure that surgery will be the preventative measure which thwarts any future health problems associated with obesity.

I do understand the health risks associated with morbid & super obesity, as well as the serious nature of any WLS. Over the years I’ve tried several weight loss measures including diet and exercise, over the counter weight loss supplements, and meal replacements. Under the care of past physicians, I had also tried numerous prescription weight loss pills, including Fenfluramine & phentermine (Fen-Phen).

Most recently I’ve completed a dietician-supervised program through [NAME OF YOUR 6-MONTH PRE-OP PROGRAM]. During this program I’ve followed the nutritional guidelines, but have found effective exercise difficult due to back and joint pain. All other attempts at significant weight loss have been unsuccessful, thus my need for the WLS.

I have discussed my current health with a few doctors and agree that it is time for a permanent resolution to eliminate present and future health issues. And considering the success rate of bariatric surgery and the health benefits involved, I feel WLS is the best solution for me.



  1. You can use The Journey BMI calculator to configure your approximate BMI...

  2. Be sure to list any co-morbidities you may have in the 2nd paragraph above...

  3. List any and all "official" diet programs you have tried in the past in the 3rd paragraph above...
Attached Files
File Type: doc wls-note_template.doc (26.0 KB, 1 views)

WLS Program :: New Life Center For Bariatric Surgery - Dr. Stephen Boyce
Lap Roux-en-Y: April 28, 2009 • Pre-op Highest Weight: 438 • Post-op Current Weight: 246

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