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24/01/2018 6:39 am
Got the letter. The phrase is “not medically necessary”. No further explanation. I have read it ten times and it tells me nothing.
24/01/2018 8:13 am
It means the reviewer did not find your documentation matched their criteria. It is a bookkeeping phrase, not a clinical judgement, even though it sounds like one. Ask for the specific criterion.
Topic starter
24/01/2018 8:33 am
Found it. It is in an exclusion table, in a subsection, under a heading I would not have thought to look under.
24/01/2018 8:44 am
Sometimes it genuinely means the service is on a list of things they do not cover in your plan, and the language is just doing a lot of work. Check the plan document for the exclusions list first.
24/01/2018 8:52 am
That is the normal answer. Sorry.