In What Order Are Things Done???

Snaggletooth · May 16, 2007

I'm confused... I went to my PMD for the "letter of medical necessity" and he said he won't write it until I have blood work, xray, EKG, maybe ENDO....etc. I thought the 1st step is the letter to get preauthorization, then all the tests came after that to clear you to have the surgery...??? Any input from the experienced banded folks ??

I'm in NJ with Qualcare as my insurance. Thanks for the help.

MEW · May 17, 2007

Each insurance company and Doctor/Surgeons office will be different.

In my case, my insurance company required a letter of medical neccessity from my PCP (PMD), a Nutritional consult, a psych evaluation and a letter from the surgeon before they would even give me a determination (approval/denial) The surgeons office required a surgery clearance from a pulmonologist (chest X-ray) which I had done prior to submitting to the insurance company.

After the approval, I then had to get the bloodwork, EKG and meet with the anesthesiologist as well as attend a pre-op education class.

Snaggletooth · May 18, 2007

Hi Mary, thanks, I attended my seminar on Wednesday and they did clear it up for me. I have my appt with the surgeon on May 29th. I'm happy it didn't take long for the appt. I already have my nutrition and psych eval done...just the pmd is holding me up !! Good luck with the surgery !!! Lori