The medical field has increasingly recognized bariatric surgery as a viable and sometimes necessary option for patients dealing with severe obesity. These surgeries can be lifesaving procedures, and yet, obtaining approval for them is often a complicated process that requires substantial documentation.
Among the essential documents needed are Letters of Medical Necessity (LMNs), which provide crucial information about the patient’s medical condition, the need for surgery, and the expected outcomes.
These letters are typically drafted by medical professionals and addressed to insurance providers, employers, or other responsible parties who will decide on the funding or approval for the surgery. Writing an effective LMN requires a keen understanding of both the medical and administrative aspects involved.
Sample Letters of Medical Necessity for Bariatric Surgery
This article offers 15 comprehensive examples of such letters. They are written to cover various situations and purposes, each providing a template or guideline for medical practitioners, patients, or caregivers who may need to draft a similar letter.
While each letter is fictional and generalized, they include realistic details that make them suitable for adaptation to individual cases.
Sample Letter 1: Physician’s Letter to Insurance Company Requesting Approval
Subject: Request for Approval of Bariatric Surgery for Patient John Smith
Dear [Insurance Company Name],
I am writing to request your urgent consideration and approval for a bariatric surgery procedure for my patient, Mr. John Smith. Mr. Smith is 40 years old and has been battling morbid obesity for more than 15 years.
Despite numerous attempts at weight loss through diet, exercise, and medication, Mr. Smith’s condition has continued to deteriorate. He currently has a Body Mass Index (BMI) of 42, which places him in the high-risk category for various associated health complications. These include type 2 diabetes, hypertension, sleep apnea, and chronic joint pain, all of which he is currently experiencing.
Given the severity of his condition and the failure of non-surgical interventions, bariatric surgery has become a medical necessity. This surgery is not only expected to help Mr. Smith lose weight but also to improve or possibly eliminate his associated health conditions, enhancing his overall quality of life.
Enclosed, please find all relevant medical records, test results, and a detailed treatment plan. I kindly request your prompt attention to this matter, and I am available for any further clarification or information you may need.
Thank you for your consideration.
Sincerely,
Dr. Jane Doe, MD
Enclosures: Medical Records, Test Results, Treatment Plan
Sample Letter 2: Surgeon’s Letter to Employer Detailing Medical Necessity
Subject: Medical Necessity of Bariatric Surgery for Employee Jane Doe
Dear [Employer’s Name],
I am writing to inform you of the critical medical condition of your employee, Ms. Jane Doe, and the urgent need for bariatric surgery to address her severe obesity.
Ms. Doe has been under my care for the past two years, and despite all conservative measures, her weight has continued to increase. Her current BMI is 45, and she is experiencing significant health complications, including heart disease, severe arthritis, and debilitating fatigue.
As her surgeon, I firmly believe that bariatric surgery is not only the best option but a necessary one for her well-being. The surgery will lead to substantial weight loss, alleviate her existing health conditions, and greatly reduce her risk of future illnesses.
I have included all necessary medical documentation to support this claim and am available to discuss this matter further if required. Your understanding and support in granting her the necessary time off and assistance for this surgery would be highly appreciated.
Thank you for your attention to this matter.
Yours faithfully,
Dr. James Brown, MD, FACS
Enclosures: Medical Documentation
Sample Letter 3: Patient’s Letter to Insurance Company Explaining Personal Circumstances
Subject: Personal Appeal for Approval of Bariatric Surgery – Case of Emily Johnson
Dear [Insurance Company Name],
I am writing to appeal to your compassionate consideration for approval of a bariatric surgery procedure that has become a necessity in my life. My name is Emily Johnson, and I have been struggling with obesity for as long as I can remember.
Despite numerous efforts, including diet plans, personal trainers, and medical interventions, I have been unable to achieve a healthy weight. My current BMI is 40, and I am plagued with health problems such as high blood pressure, depression, and chronic back pain.
My physician, Dr. Sarah White, has recommended bariatric surgery as the only viable option for me at this point. This surgery is more than a cosmetic desire; it is a crucial step towards reclaiming my health, my self-esteem, and my ability to lead a normal life.
I understand that approval processes must follow particular protocols, but I urge you to consider my individual situation, my relentless struggle, and the support of my medical team. Enclosed are all relevant medical records and Dr. White’s recommendation.
Thank you for your attention to my case, and I look forward to a favorable response.
With warm regards,
Emily Johnson
Enclosures: Medical Records, Physician’s Recommendation
Sample Letter 4: Family Physician’s Letter to Medical Review Board
Subject: Medical Review for Bariatric Surgery – Patient Robert Taylor
Dear Medical Review Board,
I am writing to present the case of my patient, Mr. Robert Taylor, for your review concerning his need for bariatric surgery. Mr. Taylor is 50 years old and has a documented history of obesity-related health complications.
His current BMI of 41 reflects the seriousness of his condition, and despite numerous attempts with diet, exercise, and medication, his health has continued to worsen. He suffers from type 2 diabetes, fatty liver disease, and severe sleep apnea.
Given the complexity of his situation and the ineffectiveness of conservative treatments, I have consulted with a specialist bariatric surgeon who agrees that surgery is the most appropriate course of action. Bariatric surgery, in this case, is not an elective choice but a life-saving necessity.
I kindly request your thorough review of Mr. Taylor’s medical records, and I am available for any additional information or clarification you may need. Your prompt attention to this matter could significantly impact his quality of life and overall well-being.
Thank you for your consideration.
Yours sincerely,
Dr. Richard Lewis, MD
Enclosures: Medical Records, Specialist’s Consultation
Sample Letter 5: Specialist’s Letter to Patient’s Primary Care Physician
Subject: Bariatric Surgery Recommendation for Patient Linda Wilson
Dear Dr. [Primary Care Physician’s Name],
I am writing to inform you of my recommendation for bariatric surgery for our mutual patient, Ms. Linda Wilson. After extensive evaluation and consideration of all alternatives, it is clear that surgery is the most viable option for her current condition.
Ms. Wilson’s obesity has led to several serious health complications, including heart disease, gallstones, and chronic migraines. Her BMI of 39, along with her persistent health issues, warrants immediate intervention.
As a bariatric specialist, I believe that surgical intervention will not only address her weight issues but also significantly improve her overall health and quality of life. I have discussed the procedure, risks, and benefits with Ms. Wilson, and she is fully committed to this course of action.
I request your cooperation in preparing her for this surgery and your assistance in postoperative care to ensure a successful outcome. Enclosed are the detailed surgical plan and all relevant medical assessments.
Thank you for your collaboration in this matter.
Best regards,
Dr. Margaret Clark, MD, FACS
Enclosures: Surgical Plan, Medical Assessments
Sample Letter 6: Spouse’s Appeal to Insurance Company for Coverage
Subject: Appeal for Coverage of Bariatric Surgery for My Wife, Susan Thompson
Dear [Insurance Company Name],
I am writing to appeal for your understanding and approval of the bariatric surgery that has been recommended for my wife, Susan Thompson. As her husband, I have witnessed her courageous battle with obesity, and I firmly believe that this surgery is a critical step towards restoring her health and dignity.
Her current BMI is 43, and she has tried every possible weight loss method under the supervision of her healthcare team. Unfortunately, none of these have brought her any lasting success. Her obesity has led to multiple health issues, including respiratory problems, joint degeneration, and depression.
The attached medical documentation outlines her medical history, the failed interventions, and the professional recommendation for surgery. This appeal is more than a request for medical approval; it is a plea for compassion and understanding of the profound impact this surgery could have on her life.
Thank you for considering this appeal, and I am available for any further information or discussion if needed.
With sincere regards,
Thomas Thompson
Enclosures: Medical Documentation, Surgical Recommendation
Sample Letter 7: Insurance Company’s Letter to Patient Approving Surgery
Subject: Approval of Bariatric Surgery for Ms. Karen Miller
Dear Ms. Miller,
I am pleased to inform you that your request for bariatric surgery has been approved. After careful review of your medical records, consultations, and the recommendation from your healthcare provider, we agree that the surgery is a medical necessity.
Your current BMI of 40, along with the related health complications, has led us to this decision. We believe that the surgery will provide you with the opportunity to improve your health significantly.
Enclosed, please find the details of the coverage, including the approved medical facility, surgeon, and the specific procedure authorized. Should you have any questions or require further clarification, our customer service team is available to assist you.
We wish you all the best in your upcoming surgery and recovery.
Yours sincerely,
[Your Name], [Your Title]
[Insurance Company Name]
Enclosures: Coverage Details, Approved Medical Facility, Surgeon, and Procedure Information
Sample Letter 8: Patient’s Thank You Letter to Surgeon After Surgery
Subject: Gratitude for Successful Bariatric Surgery – Patient Michael Anderson
Dear Dr. [Surgeon’s Name],
I am writing to express my heartfelt gratitude for the successful bariatric surgery you performed on me. Your expertise, care, and support have given me a new lease on life, and I cannot thank you enough.
The journey leading up to the surgery was filled with anxiety, frustration, and despair. But your reassuring presence and the way you explained every detail made me feel confident and well-informed. Your team’s compassionate care before, during, and after the surgery was exemplary.
I am now on the path to recovery, and already, I feel a positive change in my physical health and emotional well-being. My family joins me in thanking you for this life-altering experience.
Wishing you continued success in the incredible work you do.
With deepest thanks,
Michael Anderson
Sample Letter 9: Primary Care Physician’s Follow-Up Letter to Surgeon
Subject: Postoperative Follow-Up on Bariatric Surgery – Patient Olivia Harris
Dear Dr. [Surgeon’s Name],
I am writing to provide you with an update on our mutual patient, Ms. Olivia Harris, following the successful bariatric surgery you performed. Ms. Harris has been recovering well, and I want to express my gratitude for the excellent care you provided.
Since the surgery, Ms. Harris’s weight has been decreasing steadily, and her associated health conditions have shown remarkable improvement. Her blood pressure is stable, her mobility has improved, and her overall mental well-being has positively transformed.
I have enclosed the latest medical reports for your review, and I want to thank you for your collaboration and professionalism throughout this process. The success of this surgery has had a profound impact on Ms. Harris’s life, and I am delighted to witness her progress.
Thank you once again for your exceptional work.
Yours sincerely,
Dr. [Primary Care Physician’s Name], MD
Enclosures: Latest Medical Reports
Sample Letter 10: Patient’s Appeal to Hospital for Financial Assistance
Subject: Request for Financial Assistance for Bariatric Surgery – Peter Jackson
Dear [Hospital’s Financial Department],
I am writing to request your consideration for financial assistance regarding my upcoming bariatric surgery. My name is Peter Jackson, and after an exhaustive evaluation by my healthcare providers, this surgery has been deemed medically necessary for my well-being.
As someone who has been fighting obesity for decades, I understand the importance of this surgery for my health. However, the financial burden of the procedure is beyond my means, despite having partial insurance coverage.
I have attached all required financial documents, including proof of income, expenses, and the insurance details. I sincerely hope that you can assess my situation and provide me with some financial aid or a manageable payment plan.
This surgery represents hope and a chance for a healthier life, and I kindly request your support in making it a reality for me.
Thank you for your attention to this matter.
With respect,
Peter Jackson
Enclosures: Financial Documents, Insurance Details
Sample Letter 11: Surgeon’s Letter to Primary Care Physician with Surgical Plan
Subject: Surgical Plan for Bariatric Surgery – Patient David Lee
Dear Dr. [Primary Care Physician’s Name],
I am writing to inform you of the finalized surgical plan for our mutual patient, Mr. David Lee, who is scheduled for bariatric surgery on [date]. After a thorough evaluation and consultation with Mr. Lee, we have decided to proceed with the Roux-en-Y Gastric Bypass procedure.
Mr. Lee’s current BMI of 38, along with the presence of type 2 diabetes and high cholesterol, makes this surgery a necessity. The chosen procedure is believed to be the most suitable for his specific situation.
The attached documents outline the preoperative care instructions, surgical plan, expected outcomes, and postoperative care. Your collaboration in ensuring that Mr. Lee follows the preoperative guidelines and receives the necessary postoperative care will be essential for a successful outcome.
Thank you for your continued support, and I look forward to our collaboration on this case.
Best regards,
Dr. [Surgeon’s Name], MD, FACS
Enclosures: Preoperative Care Instructions, Surgical Plan, Expected Outcomes, Postoperative Care
Sample Letter 12: Surgeon’s Letter to Patient’s Family Explaining Procedure
Subject: Explanation of Bariatric Surgery Procedure for Mr. William Howard
Dear [Family Member’s Name],
I am writing to provide you with detailed information regarding the upcoming bariatric surgery for Mr. William Howard. Understanding that this is an essential and potentially life-changing decision, I want to ensure that you are fully informed about the procedure, the benefits, risks, and the expected recovery process.
Mr. Howard has been diagnosed with morbid obesity, having a BMI of 42, which has led to several associated health problems, including sleep apnea, hypertension, and joint pain. The surgery has been deemed medically necessary to improve his overall quality of life.
We have decided on the Sleeve Gastrectomy procedure, which reduces the size of the stomach to limit food intake. The surgery is scheduled for [date], and the expected hospital stay is [number of days].
The enclosed documents provide an in-depth explanation of the procedure, preparation, expected outcomes, potential risks, and the postoperative care plan. If you have any questions or need further clarification, please don’t hesitate to contact me or my team.
Thank you for entrusting us with Mr. Howard’s care, and we will do everything in our power to ensure a successful surgery and recovery.
Yours sincerely,
Dr. [Surgeon’s Name], MD, FACS
Enclosures: Procedure Details, Preparation, Expected Outcomes, Potential Risks, Postoperative Care Plan
Sample Letter 13: Dietitian’s Letter to Patient Regarding Post-Surgery Diet
Subject: Postoperative Diet Plan for Bariatric Surgery – Mrs. Emily Johnson
Dear Mrs. Johnson,
I hope this letter finds you well. As your dietitian, I am providing you with the comprehensive postoperative diet plan following your recent bariatric surgery. The success of your surgery depends not only on the procedure itself but also on how well you adhere to the dietary guidelines tailored to your specific needs.
The enclosed documents detail the four stages of your postoperative diet, starting with a liquid diet and gradually progressing to solid foods. It’s essential to understand that your stomach’s reduced size requires careful monitoring of portion sizes and the types of food you consume.
Please carefully review the attached materials, and do not hesitate to contact me with any questions or concerns. Regular follow-up appointments have been scheduled, and I look forward to supporting you throughout your journey towards better health and well-being.
Best regards,
[Dietitian’s Name], RD, LD
Enclosures: Postoperative Diet Plan, Stages, Portion Guidelines
Sample Letter 14: Employer’s Letter to Employee Granting Medical Leave
Subject: Approval of Medical Leave for Bariatric Surgery – Mr. James Clark
Dear Mr. Clark,
I am writing to confirm the approval of your requested medical leave for your upcoming bariatric surgery. Your leave will commence on [start date] and conclude on [end date], in accordance with the medical documentation provided.
We understand the importance of this surgery for your health, and we support you wholeheartedly. During your absence, your responsibilities will be handled by [colleague’s name], and we will ensure a smooth transition both during your leave and upon your return.
Enclosed are the details of your leave, including any necessary arrangements regarding your benefits and compensation. Should you have any questions or need further assistance, our Human Resources department is available to help.
We wish you the best for your surgery and a speedy recovery. Please keep us informed of your progress, and we look forward to welcoming you back.
Yours sincerely,
[Your Name], [Your Title]
[Company Name]
Enclosures: Leave Details, Benefits, and Compensation Information
Sample Letter 15: Therapist’s Letter to Patient Addressing Emotional Preparation
Subject: Emotional Support and Preparation for Bariatric Surgery – Ms. Laura Smith
Dear Ms. Smith,
I am writing to discuss the emotional aspects and preparation required for your upcoming bariatric surgery. As your therapist, I want to emphasize the importance of mental readiness and support to ensure a successful surgery and recovery process.
Undergoing such a significant life change can bring about various emotions, including anxiety, excitement, fear, and hope. It’s normal to experience these feelings, and I am here to help you navigate them.
We will continue our regular sessions leading up to the surgery, focusing on building coping strategies, setting realistic expectations, and developing a support network. Together, we will create a plan that aligns with your needs and ensures that you feel emotionally prepared for this new chapter in your life.
Enclosed is a guide to some exercises and techniques you can practice at home to reinforce our work together. Please do not hesitate to reach out if you have any questions or need additional support.
Wishing you strength and resilience as you embark on this journey towards improved health and well-being.
Warm regards,
[Therapist’s Name], LPC
Enclosures: Emotional Preparation Guide, Exercises, Techniques