Substantiate this

So...I gotta get my knee fixed. Just like the other one three years ago, something got loose in there and needs to go. I tried to avoid it, but it wasn't going away and it was just unbearable when it locked up. It happens. Not looking forward to the recovery, but if it works as well as the other one did, I'll take it.

Of course, my "health insurance" has a slightly different view of this straightforward matter.

I got a copy today of a letter that they sent to my doctor. They got a request from my doctor, you see, for coverage of the following services: [the knee operation]. You would think this would be sufficient, inasmuch as my doctor is a doctor who operates on lots of knees and such, but nope:

After review of the information submitted, we are unable to substantiate medical necessity for the requested service(s). To process the request, we need...clincial information supporting the medical necessity of the services requested.

Medical necessity! Ever had cartilage get stuck between your femur and tibia? It's necessary!

Well done, Claims Department at a health insurer who shall go unnamed (it's Cigna). You saw right through my plan to get me a frivolous knee operation so that I can look forward to being stuck on the couch, dealing with the pain and inconvenience post-op, paying a bunch of money out of pocket, and then not being able to run or exercise for a couple of months. If not for your vigilance and attention to detail, who knows how many people would pull off this scam?!

After my medical provider sends you the requested documents, how about you fax me some documents proving that you're not a bunch of soulless morons? I'm unable to substantiate the necessity to treat you otherwise.


David Stein said...

best damn health care system in the world. love it or leave it. USA USA USA

The Mazz said...

Very sorry to hear about this, how much was the surgery?

Santorum/Bachman 2012! said...

See what Obamacare does for you, they want to pull the plug on Grandma (or not puncture Andy's knee)