Top 5 Letter of Support Revisions

Top 5 Reasons Letters of Support Are Sent Back for Revisions

By Alex Friedman PA-C, Crane Center

The road of Top or Bottom surgery can be logistically daunting and by now you’re probably aware of the letter requirements needed for surgery. While the overwhelming majority of provider letters cover the necessary information needed to submit for surgery authorization, we find there are common letter issues that make revisions necessary—thus prolonging the time your surgery is scheduled.

1. Delayed letter submission: Letters are generally needed no later than 6 months before your surgery date for several reasons. This timing allows for review of the letter content so they can be revised if needed. Letters are usually sent to insurance for authorization 3 months before surgery, so again, that lead time is important if anything needs to be revised.

2. Out of date letter: We understand that your road of surgery has been long and seeking a provider to write a letter is definitely a proactive move. However, insurance requires letters be dated within 12 months of your surgery date. 

3. Missing letter content: It’s not enough to have a mental health or other provider write their name on a piece of paper stating they agree with your decision to have surgery. There are requirements that you may be aware of which need to be conveyed to the provider writing the letter. Look to your surgery team for documentation to provide your letter writer to make sure all the necessary content is present. 

4. Mental health provider qualifications (bottom surgery): Most insurances require that two mental health letters be submitted—at least one from a doctorate level (MD/DO/PhD/PsyD) and another from another from at least a masters level.  Delay in surgery scheduling can occur when two mental health letters are submitted by non-doctorate level providers.

5. Quality of letter submission: Letters need to be clear, legible, and printable for submission. Photos of a hard copy become problematic for reproduction such as printing and faxing. Letters should be either directly faxed or emailed as a PDF.

About the author: Alex Friedman PA-C is a certified Physician Assistant specializing in Reconstructive Plastic and Urologic Surgery, and brings over half a decade of experience working in Aesthetic and Reconstructive Plastic Surgery. Alex works primarily assisting Dr. Michael Safir in the Crane Center San Francisco office. He is a graduate of the University of California of Davis and Samuel Merritt University in Oakland.