Question:
Should I wait ???????

My surgeons office sent of my letter of pre-certification to the insurance company. I wanted to have my primary care physisan write a letter of medical nessecsity, and support of the surgery for me. Should I wait to see what the inurance company will request, or should I have my Dr. send in the letter now. Im so anxious. I think about this surgery all day long, and I call the insurance company twice a week. It hasn't been a month yet, but I can't help it. What should I do?    — aisha E. (posted on February 4, 2003)

February 4, 2003
Hi, I think you should have your PCP send anything he/she can on to the insurance ahead of them requesting it. I had a 4 month wait because I didn't know what the insurance was going to ask for and it took 4 mos to complete all the requirements for their assessment. See if you can get a checklist from your insurance of what they require to make a decision. Some insurances don't require much at all and you may be alright. I would just go on the assumption that every paper sent is a positive on your case to prove necessity of the surgery. Good Luck!
   — mbradley35

February 4, 2003
If I was in your shoes, I would have your doctor send the letter now. I would also call the insurance company and get all the necessary information that they will need from you, your PCP and your surgeon. I guess I'm one of the lucky ones. My PCP send a letter and referral to the surgeon, they called me for a few pieces of other information and they submitted. I was approved in just a few days.
   — Sue F.

February 4, 2003
I work for an insurance company. The surgeon is the one who will get the surgery pre-certified, since he is the one who will be getting paid. Your surgeon probably has someone in his office that takes care of getting the pre-certs done, and that person is (or should be) familiar with what the insurance company wants to see. This will include "medical necessity". There is no need for your primary care physician to write a letter of medical necessity. I seriously doubt that that will make any difference - if you met the insurance company's criteria, you meet it, and will be approved. If, for some reason, you are denied, then is the time to enlist the help of your PCP to provide factual information that would lead to an approval. Most likely, your request is sitting in a stack with a lot of other requests for who knows what, waiting to be processed. The hardest part about having surgery is the waiting for approval. If you have confirmed that the insurance company has the letter, that is about all you can do. To be honest, sometimes being a pest gets your request put on the bottom of the stack!
   — koogy