by celmarie » Fri Oct 01, 2010 09:35 pm
My psychologist is requesting therapy to continue on a once a week basis.I have had an int5ernal appeal and been denied. They say that the mediacl necessity ios not enough for once a month. I have physical conditions thqat are exacerbated by my depression.
What is medical necessity and hiow do I proceed>
Thank you
What is medical necessity and hiow do I proceed>
Thank you
Posted: Sun Oct 03, 2010 04:51 am Post Subject:
"Medically necessary" or "medical necessity" is generally understood to mean that life or limb would be in jeopardy without the treatment or service.
Having a heart attack often requires "medically necessary" transportation to get the victim to the ER. Having the flu and calling an ambulance to take you to the ER because you know you won't have to sit in the waiting room is not a "medical necessity" and the ambulance ride would not be covered, unless you are admitted to the hospital.
How do you proceed? A lawyer is the right person to answer that question.
Posted: Sat Oct 09, 2010 11:18 am Post Subject:
I agree that a lawyer would probably be the best person to help the OP under these circumstances. I'd also like to know if it will suffice if the doctor medically certifies it's necessity.
Posted: Mon Oct 11, 2010 09:29 am Post Subject:
They say that the mediacl necessity ios not enough for once a month.
Max, can we ask for an explanation from our insurance carrier under such circumstances?
Can we have access to such data on which our carrier rejects our claims?
Posted: Sat Jul 16, 2011 03:41 pm Post Subject: KmWxewzYYIFMh
Hey, that post leaves me feeling flooish. Kudos to you!
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