Access to Care Resources

Sample Letter for Pre-approval

Your Full Name
Your Full Address
Your City, State and Zip
Your Phone Number with Area Code

Current Date

Insurance Provider’s Name
Insurance Provider’s Address
Insurance Provider’s City, State, Zip


In your first paragraph, mention the following points:

1. Discuss how obesity affects or has affected you and your family.
2. Share A brief medical history of your struggles with this disease, including past treatments that haven’t worked for you, and any obesity-related diagnoses such as hypertension, diabetes, etc. (Remember to remain brief. A short letter can accomplish just as much as a long one.)

In your second paragraph, mention the following items:

1. My physician has recommended [INSERT RECOMMENDED TREATMENT: bariatric surgery, FDA-approved anti-obesity medications, nutritional counseling, mental health and behavioral counseling] Is this recommended procedure covered under my policy?
2. If yes, what are the requirements for authorization? What are the benefit limitations?
3. If no, are there any portions of the procedure that may be covered? What other treatment options are covered under my plan? I would like to request a copy of my policy with the pertaining exclusion sections highlighted.

In your last paragraph, discuss the following closing items:

1. Request that the insurance provider write you back as soon as possible, informing you on the procedure in question.
2. Thank them for their time and assistance.

Your Full Name

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