Submission Requirements

A Letter of Medical Necessity and weight-loss history are necessary to obtain prior authorization for obesity surgery. A Letter of Medical Necessity states why significant weight loss is medically necessary for a patient and usually includes the following information:

• Patient’s weight (which should be 100 pounds or more above ideal weight or a BMI more than 40 or at least 35 with associated medical problems to qualify)
  
  
• List of medical problems associated with obesity, such as type 2 diabetes, sleep apnea, hypertension, etc.
  
  
• Number of years patient has been overweight (which should be at least 5 or
  more)
  
  
• Number and types of failed weight-loss programs attempted in the past

If you create a document or packet listing all your weight-loss attempts (self-controlled or medically supervised) and their results, you can substantially increase your chances of getting insurance coverage for the LAP-BAND procedure. You should include any commercial diets or medical records of your weight-loss efforts.