Approval Process

Approval Process:

1) Prior to us submitting to your insurance for authorization you will need to meet the qualification requirements and have the documentation sent to our office. We require this documentation prior to your consultation to avoid delays. We will not send for authorization without the above documentation and requirements met.

2) Once your insurance company has received our pre-certification package, it typically takes them up to one month to make a determination if your case meets their criteria for approval of benefits. Once your are authorized you will be contacted for a surgical date.

3) Our office does not determine your exact benefits package prior to surgery. We will provide a Good Faith Estimate (GFE), which outlines your expected charges with and without insurance coverage.

4) You are expected to pay any determined deductibles and/or any projected co-payment and co-insurances prior to scheduling your surgery.

5) If your insurance company receives our claim for your surgery, then later determines your surgery is cosmetic, and denies our claim for payment, you will be responsible for payment to the doctor, facility, and anesthesia.

6) If you wish to appeal a denial of surgery by your insurance company, we will provide you with our letter summarizing your medical necessity, but the appeal must be initiated and followed up by you.

7) We reserve the sole right to determine medical necessity based on our criteria and have the right to refuse surgery regardless of insurance pre-authorization if appropriate candidacy are not met, surgical risks are excessive, or of the scope of the requested or necessary surgery exceed typical insurance based surgical management.