Insurance Questions
Process for Obtaining Insurance Approval
You can contact us anytime or call us: 573.882.4176
If it is determined that your child needs a medical procedure after they have been evaluated in the plastic surgery clinic, appropriate measures will be taken to obtain approval from the insurance company prior to the procedure. Often times, a telephone call to the insurance company will suffice; however, in some instances a letter of predetermination is required. The purpose of this letter is to receive a determination from your insurance company that they deem the proposed procedure (s) as medically necessary and agree to pay the claim when it is submitted.
If a letter is necessary, one will be generated detailing the child's pertinent medical information and will be sent to the insurance company along with the photos if it is felt they will help the insurance company make their determination. Insurance companies can take up to eight to twelve weeks to make a decision for a predetermination.
Once we have received notification from the insurance company, you will be contacted with the decision. If the procedure has been deemed medically necessary, we will proceed with scheduling the pre-operative work ups and the proposed procedure. If the procedure is denied as "not medically necessary" we will discuss options open to you for appeal.