How do I provide proof that the surgery is medically necessary?
Each individual will need to check with his or her policy and with a benefits representative about the documentation required. Typically, if the surgery is medically necessary, the surgeon will provide a letter stating so to the candidate’s insurance company, along with the request to provide surgery. The insurance company will then send a reply to the surgeon’s office, either approving or denying the request for surgery. If the surgery is denied, there will be a statement explaining why the surgery was denied and how to appeal the denial.
Related Questions
- The RFP states Reconstructive Surgery, includes surgery and prosthesis after medically necessary mastectomy. Is this the only reconstructive surgery that is covered?
- What happens if I choose to have a medically necessary procedure done (e.g., knee surgery) at an out-of-area facility?
- How do I provide proof that the surgery is medically necessary?
