My doctor Mary Nary also wrote a wonderful letter along with a letter that came from the Governors office after I got them on my side too. It takes work but you can do it. DON"T GIVE UP! After sending all three letters the insurance co. overturned the decision within 72 hours.
March 31, 2008
Patient Name: Gina Holman-Garcia
Subscriber Name: Norbert Garcia
Patient ID:
Case Number:
Requested Service Laparoscopic Roux-En-y with Gastric Bypass
Health Plan Name: PacifiCare
To Alan Blumenthal, M.D., PacifiCare Medical Management and all others concerned:
Please let it be known that I have done everything in my power and fulfilled all of your directives in a timely manner, to help facilitate weight loss and improve my health. *Please see attached a brief summary of 30 years of diet history. Also, attached, more detailed diet and exercise progress over the past two years, incl. but not limited to attempts and failures and success.
I have lost almost 100 lbs. three separate times in the last decade and one half. Additionally, in Oct. 2004 when I began looking into weight loss surgery as an option I went to my Dr. as a last attempt to lose the weight for good and avoid surgery. The Dr. suggested I go on the South Beach Diet. For six months this DIET worked well. I lost weight on a pretty consistent basis but then, the losing slowed and finally came to a stop. My hunger quickly came back to the forefront and rapidly increased. After losing 68 lbs. in 6 months, the weight began to creep back up slowly. Forward to, June of 2006 I had not only gained back the 68 lbs. I was gaining more than I had lost. Now, fast forward to March of 2008 I am heavier than I have ever been. I have dieted my way back up from the 68 lbs. I lost plus and extra 12 lbs. beyond that. I am heavier than ever and I can feel it all over my body. I take medication on a daily basis to control my blood pressure and acid reflux additionally, I am pre-diabetic and hoping to avoid medication to control that.
I can feel the gain and the effects it is having on me each day. I awake in the morning from a night of tossing and turning because firstly, I can’t get my mind clear of thinking about how gravely unhappy I am about being so very fat. It hurts my heart my soul and my mind in a way that there truly are no words to describe. Secondly, my back simply hurts from all the weight on it, this often leads to headaches. I know it is all the pressure. I get out of bed and my left knee feels as if it can just not bear the weight of my body any longer. As I approach the stairs to wake my boy’s I fear my knee is just going to give out and my children will wake to mommy stuck in pain at the bottom of the stairs, on the floor. I get to work to spend my day thankfully doing what I love so dearly, teaching middle school. However, standing for long periods has become a daunting task for me. I am so very tired. I am so deeply saddened whenever I think about how sorry it is that I can’t get through a day like other people. I am so tired, so tired. After I eat lunch with my colleagues, I fight with everything in me to not nod off. (I contribute this to a problem with my blood sugar as I have been advised by my PSP and Optometrist that I show all signs of being borderline diabetic) *See attached documentation. I could go on and on but I think you get the picture. These ailments are not of a 60 -80 year old person. I am a mother, a wife, a productive member of society. I am only 38 years young. I am quickly losing my health to obesity. Please, simply please help me to help myself give my life back to me. Weight loss surgery in my case, is a life saving procedure.
I am a winner; I have accomplished many great things. I have a BA in Elem. Ed. I have earned a Master’s Degree in Counseling. I am a highly decorated educator as well as mother, wife and daughter. Realistically, losing weight and keeping it off has been my only failure, I NEED MEDICAL, SURGICAL INTERVENTION.
My life is almost whole, I need you to approve me for weight loss surgery, every time I follow your directives a new one appears just at my completion please see history (incl. first it was 6 mo’s when I was almost done it changed to 12 months. I then completed the 12 months and PC said I had a hole in Feb 07 and needed 6 more months. I completed that and then you changed your policy to needing to go to Anders/Dunning.) I have in every good intention done what you asked for. I need you to approve me for weight loss surgery under my circumstances; it is the only viable solution. Please consider all that I have done already to get back my health and live my life at a healthy weight. Please find in the interest of both myself and PacifiCare financially, and myself and family spiritually.
*See attached, documentation of support for surgery and or indicators needed from my PCP, Surgeon, Psychologist, Optometrist and self.
Thank you, my kindest regards,
Gina Holman-Garcia Norbert Garcia
Just a quick summary *please note that through all these years I have received counseling via medical, psychological and persons assigned to weight loss programs to aid in my weight loss attempts.
1979 – 10 years old – Mother takes me to Weight Watchers – I reach goal after losing 8-12 lbs.
1983 to 1985 – 14 to 16 years old – Mother packs my school lunches with diet bars called Figurines.
1987 Starved 18 years old. Starved myself and lost almost 100 lbs. came back on as soon as it came off.
1989 to 1997 – 20 to 28 years old. Weight Watchers lost 99 lbs. as soon as I hit goal it started coming back on again. I gained until I hit about 160 and kept it off.
1998 to 2004 – 29 to 35 First pregnancy in 1998 gained up to around 240, never lost any of the baby weight. Pregnant with second child 2003 gained up to 279.
2004 – 2006 – 35 to 37 Dr. ordered South Beach Diet I worked with the Dr. and online with the company. I lost 68 lbs. only to see it quickly return and reach a new highest weight.
2006 – 2008 present– 38 years old have done every commercial diet, exercise, pill you name it. I weighed in yesterday at doctors office at 290 lbs. I am on medications for obesity related health issues. I am so very depressed about my weight. I have dieted myself fat. I admit I need medical, surgical intervention proven through all other methods over 30 years.