What does 'clinical review required' mean?

[sawyersmommy 11]

I just got a letter from insurance approving my surgery but it says something on there about a clinical review being required. Has anyone ever heard of this or know what it is?

[SoccerMomma73 1,867]

Happens all the time. Just means your file is either going to a nurse or physician for review to see if you qualify. Bariatric surgery rarely gets a simple yes or no answer since so many variables are involved. No worries, it will be fine!

HW 312, pre-op (RNY) 255, current weight 199

[sawyersmommy 11]

Happens all the time. Just means your file is either going to a nurse or physician for review to see if you qualify. Bariatric surgery rarely gets a simple yes or no answer since so many variables are involved. No worries' date=' it will be fine!

HW 312, pre-op (RNY) 255, current weight 199[/quote']

Does that mean it will take longer to get a date? I've been getting the run a round from the clinic for a long while. They turned my stuff into insurance but didn't want to because they didn't think my paperwork was good enough to get accepted. I've been working on this for over a year.

[SoccerMomma73 1,867]

Does that mean it will take longer to get a date? I've been getting the run a round from the clinic for a long while. They turned my stuff into insurance but didn't want to because they didn't think my paperwork was good enough to get accepted. I've been working on this for over a year.

Depends on insurance company policy. Typically, if it's not an emergency situation, they'll get you an answer in 2 weeks or so...my question is why don't they think your paperwork is good enough to get accepted??? If your been doing this for a year they should have tons of information.

HW 312, pre-op (RNY) 255, current weight 199

[MamboMan 6]

Does that mean it will take longer to get a date? I've been getting the run a round from the clinic for a long while. They turned my stuff into insurance but didn't want to because they didn't think my paperwork was good enough to get accepted. I've been working on this for over a year.

Why did they think your paperwork wasn't "good enough" to get accepted? If they didn't think it would be approved, why did they bother submitting?

I know my info had to go to a nurse for review, then it was given to the medical reviewer (not sure if that is a nurse or MD). It took a few days because they were supposedly backed up. My surgeon's office called to let me know I was approved. For some reason my insurance doesn't send me an approval letter, they just give it to the surgeon. I called several times just to make sure I was really approved.

[sawyersmommy 11]

Depends on insurance company policy. Typically' date=' if it's not an emergency situation, they'll get you an answer in 2 weeks or so...my question is why don't they think your paperwork is good enough to get accepted??? If your been doing this for a year they should have tons of information.

HW 312, pre-op (RNY) 255, current weight 199[/quote']

I went through everything on a military base starting one year ago. I even had a surgery date scheduled for August of 2012 then both my surgeons were deployed and there was no one else on base that could do it. So I was out on hold until they got a new doctor. In the meantime we moved back closer to my family and I had to find a non military clinic to have the procedure done. I got all my paperwork transferred and did the things they asked me to do but they didn't like the military's paperwork about my diet. They said it didn't show enough and insurance wouldn't accept it. I told them that I had already been in contact with insurance and they said I was good and asked them to at least try turning it in and we would k now what I needed to redo if anything. So they did turn it in and I got my approval on Friday in the mail. I called the clinic and they asked me to fax them a copy of the letter cause they want to review it.

[SoccerMomma73 1,867]

I went through everything on a military base starting one year ago. I even had a surgery date scheduled for August of 2012 then both my surgeons were deployed and there was no one else on base that could do it. So I was out on hold until they got a new doctor. In the meantime we moved back closer to my family and I had to find a non military clinic to have the procedure done. I got all my paperwork transferred and did the things they asked me to do but they didn't like the military's paperwork about my diet. They said it didn't show enough and insurance wouldn't accept it. I told them that I had already been in contact with insurance and they said I was good and asked them to at least try turning it in and we would k now what I needed to redo if anything. So they did turn it in and I got my approval on Friday in the mail. I called the clinic and they asked me to fax them a copy of the letter cause they want to review it.

You're set sister!!! Congratulations! If you got an approval from insurance, your only issue is getting your surgical team to schedule it. There really shouldn't be a problem from this point!

HW 312, pre-op (RNY) 255, current weight 199

[MamboMan 6]

I went through everything on a military base starting one year ago. I even had a surgery date scheduled for August of 2012 then both my surgeons were deployed and there was no one else on base that could do it. So I was out on hold until they got a new doctor. In the meantime we moved back closer to my family and I had to find a non military clinic to have the procedure done. I got all my paperwork transferred and did the things they asked me to do but they didn't like the military's paperwork about my diet. They said it didn't show enough and insurance wouldn't accept it. I told them that I had already been in contact with insurance and they said I was good and asked them to at least try turning it in and we would k now what I needed to redo if anything. So they did turn it in and I got my approval on Friday in the mail. I called the clinic and they asked me to fax them a copy of the letter cause they want to review it.

Hooray!!! Congrats!!! I'm sure you are very excited.

[sawyersmommy 11]

Thanks! I'm just still afraid ill hit another roadblock. It seems like every time I get close something else stops the whole thing. And all the while my health is getting progressively worse.

[SoccerMomma73 1,867]

I was the same way. After waking up from my band removal WITHOUT an RNY I really didn't believe it would actually happen until I woke up after the next surgery with an RNY! I just knew something else would happen!!!! Try not to fret and enjoy the moment you deserve this!