insurance question

Hoping you folks can help me here... I got a note from my insurer stating the following: This request is pended for documentation of medical necessity for Inpatient Admission for procedure code 43644. This information is needed to complete the review. Now I know my primary provided a note of med. necessity, but does this mean my center or surgeon also need to submit a not stating why it must be an inpatient service as rather than outpatient? Or maybe I'm making it too simplistic...but c'mon, really??? Good grief! Thanks for the help!

Jave jane, Hi, Well it sounds to me like they need more proof that it is medically neccisary to do the wls impatient surgery. they are not saying that they are deniing the fact that you have to stay in the hospital but that they need more info in order to approve for the impatient surgery. Sounds confusing. But look on the brite side of things they didn't say no. Call you Dr first thing tuesday morn and ask them what more do they neeed. I hope this helps you. Hang in there. Sheila

Hello - quit panicking and call Joann at the office.  That is sort of like what I was sent and you know that mess.  She will take care of it.  Good luck. 

Yep, that's what it amounted to. It appears the insurer's fax did not receive the 17 pages of documentation sent by the clinic, so they had to resend. Now back to waiting...waiting...waiting.... ARRGGHH!!