Wiki Mole removal on patient's entire body

[debneas]

We have a patient who would like every mole on his entire body removed. He just doesn't want them there and has a family history of melanoma (father). The physician does not think any are clinically suspicious, but whatever he removes must be sent for pathology. How can this be justified?

 

[CatchTheWind]

My understanding is that the decision about whether or not something is medically necessary is the provider's, not the patient's. So if the provider does not think they are suspicious, then it's not medically necessary, and no claim can be sent to insurance.

If the payer is one that will consider pre-determine requests, I suppose you could send an inquiry. But I would be careful to note that this is being done at the patient's request due his to concern about family history, rather than making any misleading statement about the provider's believing that it is necessary. I would be surprised if they approve it.

 

[JesseL]

The doctor can biopsy whatever he feel is suspicious and at the same time removing them but only if he feel's the medical need to. everything else that doesn't look suspicious or medically necessary he should consider them cosmetic removals and have the patient pay out of pocket. The patient should sign a form that he is aware these are cosmetic and will not be billed out to insurance. The patient being a hypochondriac doesn't make the removal medically necessary.