Medical Necessity?

[KLEE3 1]

has anybody's insurance required that you have your dr. or surgeon send in a authorization that the surgery id a medical Necessity?

What I want to know is how they determine whether it is or not?

And I have done diets and plans but I don't have all of that information still then what happens when the require documentation of your past efforts?

So much work on our part INSANE

[DELETE THIS ACCOUNT! 12,703]

Yes, I had to actually get documentation from my primary care physician stating he felt the surgery was medically necessary.

Just go to your doctor and tell them what you need. Hopefully they'll be eager to help you.

[RhondaMarie 67]

MOST of this depends on your insurance payor. Each plan for each payor may have different requirements.

My surgeon asked my PCP for a med nec letter. They find that less procedures are denied if they provide everything up front. It's not like I had weight watcher or gym reciepts to turn in.

The biggest factor for me to "pre-qualify" was BMI and it helps I have co-morbids.

My insurance does require the 6 months of supervised weight monitoring.

I am not exactly sure if the surgeon requires or the insurance requires all of the other pieces. in my case those pre-op studies included:

1. EDG (found hiatal hernia)

2. sleep study (found sleep apnea)

3.

[MrsJroChicago 32]

As others have said, it depends upon the insurance company. I would suggest calling them yourself and finding out EVERYTHING your doctor has to provide. They will fax you a list if you ask. Stay on top of the doctor's office to make sure they send everything in a timely manner. Good luck and keep on top of everyone!

[Maddysgram 6,159]

I have Aetna and yes I needed a letter of medical necessity. It's no big deal. Just a statement that my weight is going to kill me if I continue down this path.

[KLEE3 1]

Thank you everybody for all of your advice.

My BMI is 46

Obstructive sleep Apnea

Depression(Don't know if that is a Co-Morbid)