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
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