Insurance letter: "not a denial"
So my surgeon's office sent off paperwork for approval on the DS with gallbladder removal on March 31. Got a letter 4/1 on the 5th.
The letter said nothing of the DS...they have an issue with the gallbladder! lol
"After review of the information submitted, we are unable to substatiate medical necesity for the requested service(s). (remove gallbladder 47600). To process your request, we need the following additional information: Fax any pertinent clinical information supporting the medical necessity of the services requested to....."
At the end it says: "Plese be aware this is not a denial. Once clinical information is received from the provider we will make a medical necessity decision on your case."
So good news....they don't have a problem with the DS (yea!), and my gallbladder won't hold the surgery up. Even if they don't have approval ahead of time, they can still take it out in surgery. That pesky gallbladder could get nicked so easily, and once nicked it's just easier to take out. (hey I'm an old surgery nurse...I know how it works).
And other good news, at least the insurance company worked fast for this thing at least. lol
lisa
The letter said nothing of the DS...they have an issue with the gallbladder! lol
"After review of the information submitted, we are unable to substatiate medical necesity for the requested service(s). (remove gallbladder 47600). To process your request, we need the following additional information: Fax any pertinent clinical information supporting the medical necessity of the services requested to....."
At the end it says: "Plese be aware this is not a denial. Once clinical information is received from the provider we will make a medical necessity decision on your case."
So good news....they don't have a problem with the DS (yea!), and my gallbladder won't hold the surgery up. Even if they don't have approval ahead of time, they can still take it out in surgery. That pesky gallbladder could get nicked so easily, and once nicked it's just easier to take out. (hey I'm an old surgery nurse...I know how it works).
And other good news, at least the insurance company worked fast for this thing at least. lol
lisa