Blue Plans and Medical Necessity

To the Editor.—  The "Blue Plans Medical Necessity Program" (241: 2607, 1979) is made mandatory not just by fiscal restraints, but also by the daily problems that arrive at the offices of the intermediaries for Medicare as well as the Blue Plans. I have just retired as medical consultant to Travelers, Railroad Retirement, part B Medicare, covering nine upper Midwest states, with offices in Lansing, Ill. We were fortunate in having two superb nurses who made initial decisions of problems brought to them, with those too inexplicable referred for a medical decision.Following are a few examples that usually necessitated a telephone call to a physician even after receiving the requested operative report or progress notations on the hospital record: (1) Sometimes the diagnosis sent in was not related to examinations and tests; this was almost always due to the physician's failure to verify what his office had sent in.