|Here is the letter I wrote to my insurance company in order to have my
insurance paid for. If you want a copy of this... shoot me an
To: ABC Insurance
Re: Claim Review Board
Name of Patient/Insured: Jane Doe
Social Security/Insured ID#: XXX-XX-XXXX
Employer: ABC Company
Group No: 12354
Dear Sir or Madam:
Please let this letter serve as my petition to you to have my laparoscopic
Roux-En-Y gastric bypass surgery paid at the in-network benefit level, even
though my surgeon is not an in-network provider.
Once I decided I needed this surgery, I began my search for a surgeon by
contacting the American Society for Bariatric Surgeons (ASBS). I learned from
the ASBS that the only surgeon in my local area who is a member of ASBS is Dr.
#####, here in Columbus, Georgia. Dr. #### is an in-network
provider with Quality Healthcare Partnership (QHP). However, when I called Dr.
####ís office, I found that the only type of weight loss surgery he does
is the "open" Vertical Banded Gastroplasty (VBG).
After and entire year of researching the various weight loss surgery procedures,
I have concluded that I do not want to have the VBG procedure for several
reasons, most importantly, the high rate of revision surgeries that VBG patients
require. Furthermore, VBG patients lose a lower percentage of their excess
weight and have a greater chance of gaining the weight back.
The type of surgery which I feel is best for me is the laparoscopic Roux-En-Y (RNY)
surgery. I have chosen this surgery because it is considered to be the "gold
standard" for bariatric surgery. Studies have shown it to be the safest, most
effective surgery for losing weight and maintaining the loss. The Roux-En-Y
surgery is performed both open and laparoscopically. My research revealed that
the laparoscopic approach is, by far, superior to the open surgery for many
reasons. First, and most importantly, the laparoscopic surgery does not require
the long, vertical incision that the open requires. All that is required are 5
or 6 small incisions which range from ľ" to Ĺ" in length. Open RNY surgeries
usually require 5 to 7 days in the hospital and a 6 week period of recovery at
home, whereas the laparoscopic RNY surgery typically only requires a 2 day
hospital stay and less than a week of at-home recovery. I see no valid reason to
spend seven (7) weeks in recovery and out of work with the open surgery when I
can spend just one (1) week out with the laparoscopic surgery. (In addition to
unnecessary personal discomfort and inconvenience that a longer hospital stay
would require. A longer hospital stay equals higher medical expenses, which, in
turn, means greater overall costs.) Furthermore, there is a risk of developing
hernias with an open surgery that just simply does not exist with the
laparoscopic surgery. Hernias require additional surgeries which results in even
greater expenses to the insurance company. Add to that the risk of potential
complications with a large incision, and the choice is clear. Laparoscopic
surgery is the only choice for me.
During my year of researching weight loss surgery, I also researched surgeons
all over the United States. I was pleased to find that one of the premier
bariatric surgeons in the country, Dr. J.K. Champion, is here in Georgia. In my
research, I found that Dr. Championís qualifications are second to none. He has
performed over 700 laparoscopic weight loss surgeries. He has written numerous
surgical textbook chapters and actively publishes articles on advanced
videoscopic surgical techniques he has developed or refined. He lectures and
teaches extensively in the United States, Europe, and Asia. He is on the faculty
of Mercer University School of Medicine and Emory University School of Medicine.
Dr. Mark Fortson, my gastroenterologist physician, recommends and has referred
me to use Dr. Champion stating that "Dr. Champion is the best of the best. I
feel comfortable and confident referring you to him". With that said, no surgeon
could possibly be more qualified.
In addition to his stellar qualifications, Dr. Champion has demonstrated a level
of commitment to the health, well-being, and continued aftercare of his patients
that most doctors would never even consider. He leads not one, but two
(2) live support groups, an online support group, and a chat room for his
patients. He has even hired a personal trainer to teach an exercise class for
his patients, at no cost to the patient. Dr. Champion is highly qualified,
highly skilled, highly experienced, and cares deeply about each and every one of
his patients. For these reasons, he is my only choice for a surgeon.
Since Dr. Champion is not an in-network provider, and there is no in-network
provider in my area that does the laparoscopic Roux-En-Y procedure, I
respectfully request that you grant my request to cover my surgery with Dr.
Champion at the in-network benefit. I thank you in advance for your kind
consideration in this matter, and look forward to hearing from you in the very