Can't get answers--

I Can't get answers from anyone; Surgeon (he is not contracted with our provider but he is the only doc doing surgery at the only hospital that is considered "in network" for us), insurance, or benefit specialist at work. Should I have my primary doctor send a letter of medical necessity to Fiserv Insurance, keep emailing my benefit spec., or call the insurance commissioner? How should I proceed? I know this is an approved procedure,but can't find out what documentation needs to be provided to insurance.  The following is the response I got from my insurance for my request for inform. concerning requirements needed to qualify:  Unfortunately I am not able to send this out.  Please have your provider send in a letter of medical necessity along with the medical records for review.  If our review team requires futher information they will then contact you or the provider with this information.   The mailing address is: Fiserv Inc.  attn: Claim Consult PO Box 8023 Wausau,  WI  54402-8023  I AM SO CONFUSED!!!

The surgeon needs to send in the pre-d (predetermination) asking for surgery for you to get these answers. They are obligated to answer that in writing. You will find out if your surgeon is covered, and if you need any more info sent to them for approval. What is your surgeon waiting for???

I work with Fiserv in Wausau, WI a lot.  In fact they were just bought out by UMR but the criteria remains the same.  I can tell you generally but if you still want the specifics email me and I will email you the criteria from my office.  Generally speaking the criteria is: 1. a 6 month weight loss supervision with your MD or a professional program like weigh****chers or a hosp program meets that requirement.  Make sure it is 6 consecutive months with records of each visit. 2.  3 year Morbid Obesity history documented in medical records 3.  Psychological Eval 4.  Nutritional Consult 5.  Exercise Consult (with physical or exercise therapist) 6.  TSH (thyroid) level 7.  3 months in a pre surgical bariatric program.  I have our patients sign in at our support group meetings. 8.  Primary MD letter With all of the self funded plans I work with, all use the Fiserv criteria for medical necessity. Hope this helps. Mary E