Question:
Help! Ins co couldn't determine if it is Med Nec! Sent to an
What does this mean? The book says it covers WLS in the specific case of MO, my BMI is 51 but I don't have really any of the bad co-morbs. . . Why couldn't my own insurance review board figure it out and how long will this take?? My appt with the surgeon is in two weeks and it's a 6 hour drive! How can I speed this up too? thanks in advance! — ChristiMNB (posted on March 12, 2001)
March 12, 2001
OOps, this didn't take my whole question, which was, "The insurance Co
review board could not determine if it was Med Nec so they sent it to an
"outside review board" What does this mean??. . .question
continues as it posted! Thanks! =)
— ChristiMNB
March 12, 2001
Christi,
I found it to be in a lot of cases the ins. company often sends the claim
to outside medical review boards to determine the necessity, because this
is an expensive surgery they just want to make sure they are getting their
monies worth. I do believe this to be pretty standard. they just want to
have dr.'s to review the case for approval.
Hope I was able to help, good luck,
— Bonnie S.
March 17, 2001
I work at a third party administrator for health insurance.
Usually when a preauth is sent for outside review it means that the
insurance company sent it to a group of doctors for them to review. Make
sure your Dr knows that it has been sent for outside review, he/she may be
able to help by writing another letter to the review board.
I have seen many outside reviews come out in the patients favor. Don't
worry ( I know this is easy to say but you can always apppeal) until you
get the answer.
Some insurance companies allow person to person appeals. If yours does, I
would appeal in person (it may be harder for them to say no if you are
there in person).
— Ginny N.
March 18, 2001
Thanks to all who answered so supportingly. . .supportively?? =) Just to
let you know you are right, I got approval just a few days ago from the
outside agency. They gave me approval on WLS AND for the BPD/DS!! I feel
like I have won the lottery! =) Thanks again for the reassurance!
— ChristiMNB
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