Can anyone tell me what a letter of necessity is & why my insurance is asking for it?

I have Cigna PPO insurance. I was told by the insurance company today that they sent a letter to my surgeon requesting more information. They need a letter of medical necessity. What exactly is that? Where do I need to get that from? My surgeon or my medical Dr. (PCP). Does this mean potential problems down the road or that they may deny me? Also, why didn't my Drs. office send that information in the first place? Any infomation to help me through this would be greatly appreciated!

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