To Whom It May Concern:

This letter is asking for surgical authorization for Laparoscopic Gastric Bypass for the reasons listed below. 

I am a 25-year-old morbidly obese female who is 6 feet tall and weigh 398 lbs., giving me a body mass index of 53.  The degree of obesity associated with a particular BMI ranges from mild obesity at a BMI near 27, moderate obesity at a BMI between 27 - 30, severe obesity at 30 - 35, to very severe obesity for patients with a BMI of 40 or greater. Therefore, I may be classified as being very severely obese. The annual number of deaths in America attributable to obesity has been estimated to be 300,000 deaths per year. With my abnormally high BMI, I am at an estimated 190 percent increased risk of death at my present weight.

I am having significant adverse symptoms from my obesity. I have difficulty standing as my job requires, performing my daily activities, and it has become exceedingly challenging for me to participate with my family and friends in recreational activities.  I suffer from hypertension, acid reflex, urinary incontinence, laps of depression, aching feet and severe back pain which spreads into my legs, and because of those pains and aches in my back and legs, I have difficulty sleeping, and therefore, am fatigued and tired during the day. This surgery usually cures acid reflux, urinary incontinence, hypertension and sleep disturbances.

My family history is as follows:
On both sides of the family, approximately 75% of all known relatives are obese. 
Mother: Arthritis in knees and hips and breast cancer at the age of 43 (which has a greater occurrence rate in obese individuals than those with a BMI of less than 30). 
Mothers father: Adult onset diabetes and hypertension. 
Father:  Hypertension and a herniated disk in his back at age 45.
Fathers father: Hypertension and heart disease that resulted in a quadruple bypass at the age of 52.
Fathers mother: Suffers from depression and has arthritis in her knees.

I have made many, many attempts to lose weight and this has gone on all my life. Attached, please find my medical records from 1997 to present.  I was put on Meridia several times by my doctor to help lose weight but I suffered from severe side effects including stomach pains, oral ulcers, and nausea.  I have tried The Diet Center, Slim-Fast, Richard Simmons, The All American Slim-Down, The Carbohydrate Addicts Diet, The Atkins Diet and various exercise programs.  As you can see, I have spent all my adult life trying to lose weight. I am now at the point where everything is an effort. I have functional impairment in the activities of daily living. This dysfunction impacts sleep, recreation, work and social interactions.

In addition, I inquired with Maryland State Senator Barbara Hoffman regarding Senate Bill #522, which was signed by the Governor on May 18, 2001.  This bill was concerning the coverage required by Health Insurance Plans in Maryland to cover the treatment of morbid obesity (if medically necessary) and it became effective on October 1, 2001.

As you can see I have exhausted all the traditional ways to lose weight. The gastric bypass is an approved and proven means to permanently lose weight. Please approve this surgery for me.  Letters from my Primary Care Physician and my Bariatric Surgeon are available upon request.  Thank you.

Sincerely,

My PCP's first letter to United Healthcare:

SOON TO COME!!!

My Appeal letter to United Healthcare:

This letter is asking for surgical authorization for Laparoscopic Gastric Bypass for the reasons listed below. 

I am a 26-year-old morbidly obese female who is 6 feet tall and weigh 414 lbs., giving me a body mass index of 56.  The degree of obesity associated with a particular BMI ranges from mild obesity at a BMI near 27, moderate obesity at a BMI between 27 - 30, severe obesity at 30 - 35, to very severe obesity for patients with a BMI of 40 or greater. Therefore, I may be classified as being very severely obese. The annual number of deaths in America attributable to obesity has been estimated to be 300,000 deaths per year. With my abnormally high BMI, I am at an estimated 190 percent increased risk of death at my present weight.

I am having significant adverse symptoms from my obesity. I have difficulty standing as my job requires, performing my daily activities, and it has become exceedingly challenging for me to participate with my family and friends in recreational activities.  I suffer from hypertension, acid reflex, urinary incontinence, laps of depression, plantar faciitis and severe back pain which spreads into my legs, and because of those pains and aches in my back and legs, I have difficulty sleeping, and therefore, am fatigued and tired during the day. This surgery usually cures the above comorbidities.

Along with the obvious physical difficulties of being super morbidly obese, I suffer from gastritis, obstructive sleep apnea, edema, hypertension, urinary incontinence, plantar faciitis, osteoarthritis in both knees, pain in my hips when walking, rashes, acne, boils, shortness of breath, constant pain in my ankles and elbows, depression, aching feet and severe back pain which causes pain and numbness in my thighs.  Gastric Bypass is a proven cure for all of these comorbidities.   Please see my below family history to see my increased risks for diabetes, breast, endometrial or colon cancer, herniated/slipped disks, heart disease, stroke, gallbladder disease, skin infections, kidney stones, and more.

My family history is as follows:

On both sides of the family, approximately 75% of all known relatives are obese. 
Mother: Arthritis in knees and hips and breast cancer at the age of 43, breast reconstruction at age 51 and a mini stroke at age 52.
Mothers father: Type II Diabetes, heart disease, stroke and hypertension. 
Father:  Hypertension, kidney stones and a herniated disk in his back at age 45.
Fathers father: Hypertension, Type II Diabetes, heart disease (quadruple bypass at the age of 52) and neuropathy which took his life at age 77.
Fathers mother: Depression, high blood pressure and arthritis in her knees.

I have made many, many attempts to lose weight and this has gone on all my life. Attached, please find my medical records from 1997 to present.  I was put on Meridia several times by my doctor to help lose weight but I suffered from severe side effects including stomach pains, oral ulcers, and nausea.  I also was put on a diet by my nutritionist but have not succeeded in losing more than 3 lbs in a month.  Commercial diets are as follows: The Diet Center, Slim-Fast, Richard Simmons, The All American Slim-Down, The Carbohydrate Addicts Diet, The Atkins Diet and various exercise programs including joining several gyms.  As you can see, I have spent all my adult life trying to lose weight. I am now at the point where everything is an effort. I have functional impairment in the activities of daily living. This dysfunction impacts sleep, recreation, work and social interactions.

Gastric Bypass surgery involves reducing the size of the gastric reservoir.  Eating behavior changes dramatically, making it impossible for the person to consume large quantities of calories.  This reduces the overall hunger and daily caloric intake and ensures that the patient practices modification.  I have thoroughly researched the different types of weight loss surgeries.  After this extensive research, I am convinced that the Laparoscopic Gastric Bypass (Lap RNY) is the safest and most effective procedure.  Especially of concern to me when researching the Gastric Bypass surgery was the fact that 20-30% of all patients who receive the open procedure have further incision complications including, but not limited to infection and hernia(s), requiring additional surgery.  That is why I have chosen the Laparoscopic procedure.

A recent study (Duke University) compared cost/effectiveness of medical vs. surgical management of obesity and concluded surgery was a less costly treatment option for those with extreme obesity and had a significantly greater success rate.  Surgical patients had a 90 percent successful weight loss at year 5 compared to only 21 percent in the medical group. The cost per pound lost for medical therapy exceeded the cost of surgical therapy in the sixth post-treatment year.[i]

Obesity has been shown to directly increase health care costs. In an article in the March 9, 1998 issue of the Archives of Internal Medicine, 17,118 members of the Kaiser Permenente Medical Care Program were studied to determine the association between body fatness and health care costs. The results showed that patients with BMIs greater than 30 had a 2.4 times greater risk for increased inpatient and outpatient costs than patients with BMIs fewer than 30. For patients with BMIs greater than 30, the study also showed increases in health care costs related to diabetes, depression and hypertension.[ii]  [iii]

Beliefs about the role of personal responsibility and weight control are perhaps the most significant obstacle to health insurance coverage. A great many health care conditions involve personal behavior. Hypertension, diabetes, sexually transmitted diseases, including HIV/AIDs, and sports injuries all involve as much if not greater personal behavior than obesity. Some thirty-percent of all cancers are reportedly due to diet, nutrition and physical inactivity. Skin cancer may be due to persons who are genetically susceptible exposing themselves to the sun without proper personal protection. But their skin cancer costs are reimbursed. [iv]

I have already begun to prepare and make adjustments in my life for this surgery.   I am dedicated to leading a healthy life before and after this surgery.  I have been taking vitamins for 3 months including a multi-vitamin, sublingual B-12, calcium citrate and iron.  I walk for 20 minutes 3 times a week, have seen a nutritionist (at my own cost), drink 60-70 ounces of water a day and have overcome my biggest hurdle, smoking.