Medical Necessity

I received a letter from ICHIA today and basically said they won't certify services due to the they have been unable to obtain sufficient information for medical necessity---am I screwed? I know I need more info, but what?I'm really bummed..Help.

you have to appeal, you need to know why they did not deem it medically necessary....so it is not like they do not cover it, you just have to show medical reasons why they should pay for it

Yeah...what Angie said Just get a Letter of Medical Neccesity from your doctor listing your co-morbidities and it needs to say that the WLS is medically neccesary to reduce or eliminate the other problems...the doctor knows what to say...contact your WLS surgeons office and have them send the letter. Hope this helps

Thank you ladies for the great advice. I will contact Dr. Jones' office in the a.m. I thought the letter that came with my packet of stuff was the medical necessity letter. My pcp also gave me a letter to send maybe it just wasn't enough.Both letters listed my comorbitities.

they may be wanting weigh ins, they may want to see you have tried diets...doubtful they just want a letter...my guess is dr notes, for so many months or years

Hi, Yup, that is what happened to me the first time I applied. I had a Dr. who didn't write down my visits for diet,weight,etc. I would definatly call your PCP & ask them to give you a copy of your wt. loss efforts;meds;& all the things they have documented for the past yr.or 2,that might be from your weight. ( I had to write out every diet I had been on in the past 5 yrs.;my comorbidities, & why I felt I needed to have surgery.) Just a thought- Do you go to the Support Groups? It did help me to get the info I needed; & to support my decision. I got a "proof of attendance" letter at each one, which I had to fax to my Surgeon, & Ins. for 10 months-2 times a month. I must say it helped me so much to hear how people coped afterward; get my "pre-opt" qustions answered; know that I made the right choise; & make new friends along the way. I wish you all the best in your journey. (((hugs))) Ellen