Question:
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! — Allison T. (posted on January 31, 2002)
January 30, 2002
Yes, there is a great website with lots of data. www.asbs.org Link to
'rationale for surgery' then scroll down to 'results'. I hope this helps
and enjoy your journey!
— Cheri M.
January 30, 2002
Yes, there is a great website with lots of data. www.asbs.org Link to
'rationale for surgery' then scroll down to 'results'. I hope this helps
and enjoy your journey!
— Cheri M.
January 30, 2002
Sorry, somehow my response got posted to the wrong question. Probably my
fault.
— Cheri M.
January 30, 2002
The "Letter of medical necessity" has to be written by your pcp
or by the surgeon. It's exactly what the name implies, an explanation
of the medical reasons necessitating the surgery. Some insurers require
them...some do not; so docs don't automatically send them. They submit
them
upon request only. Call your insurer and find out the name and exact
mailing
address of the medical reviewer. Then call the admistrator at your doc's
office
and tell her (nicely) to send the letter to that person. Make sure your
name, date
of birth and insurance id number are on the letter. I'd give them two
weeks and
then I would follow up with the docs office (to make sure the letter went
out) and
with the insurance reviewer (to make sure they received the letter). I
work for a
medical facility and worked for a health insurance company for over ten
years.....so
I know both sides.
— [Anonymous]
August 12, 2003
What are insurance companies looking for when thay say medically necessary.
Are they looking for 100 lbs. overweight, high BMI or co-morbidities?
— aturbyfill
Click Here to Return