What does this mean in denial letter??

brandonbrooke
on 5/7/07 12:04 pm
I recieved my denial letter that basically states this as a reason: The medical need for this service /procedure is not supported by the submitted documentation. The number of weeks/sessions/services approved is based on records submitted by the provider. I completed the required 6 months supervised medical diet, have co-morbidities (SP?) BMI greater then 45. Please help! My doctor didnt think I would have any trouble with approval?? Any ideas on exactly this letter means??? Thanks!!!
bmbutler
on 5/7/07 9:25 pm - Winterville, NC
The insurance company does not see the surgery as medically necessary.  Can you find out what their criteria is?  You can appeal their decision.
gary viscio
on 5/7/07 10:34 pm - Oceanside, NY
RNY on 07/01/03 with
Based upon what you wrote you shouldn't have any trouble.  Make sure your doc submitted all of your medicals.  It is common for someone somewhere to miss something. If they did, then you should appeal it because they are clearly wrong.
Gary Viscio
www.ObesityLawyers.Com
RNY 7/1/03  -166lbs
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