? re: clinical notes

Toy T.
on 1/4/12 5:24 am
DS on 02/22/12
Hey everyone,

Hope you are doing well. I have a question. My file is pending insurance approval. i called today and they said they are waiting on clinical notes from Dr. K. I have never seen Dr. K since he is in CA and I am in CT. What possible clinical notes could he provide them with?  I am sitting over here stressing out bc I had a horrible dream last night that I was denied. Is anyone familiar with insurance wanting this and how would Dr. K's office provide them. I have Anthem BCBS
(deactivated member)
on 1/4/12 5:44 am, edited 1/24/12 5:33 pm

Toy T.
on 1/4/12 5:53 am
DS on 02/22/12
 I have never spoken with him directly. i have only spoke with his assistant. He has my medical records from my pcp and my most recent ct scan that was done in November as well as my psych eval. 
(deactivated member)
on 1/4/12 5:57 am, edited 1/24/12 5:33 pm

Toy T.
on 1/4/12 6:06 am
DS on 02/22/12
 thanks so much. i thought maybe I would have to fly down therr just for a consult.
fullhousemom
on 1/4/12 6:03 am
For technical cases, it is common for insurance companies to have independent physician reviews to process and review claims. In this case, perhaps they are relying on him to make an independent decision to determine if your claim/proposed surgery should be covered. 
Toy T.
on 1/4/12 6:07 am
DS on 02/22/12
 so the independent medical wants more notes to justify this?
Toy T.
on 1/4/12 6:25 am
DS on 02/22/12
 Dr. K's office told me that they can write a letter of medically necessity but thats all they can do bc they havent seen me so I will call the pre auth dept tomorrow and get more information.
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