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Video instructions and help with filling out and completing Bariatric Surgery Predetermination Request Form BlueCross
Instructions and help about Bariatric Surgery Predetermination Request Form BlueCross
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People also ask
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What is a predetermination form?
“predetermination: A process where a dentist submits a treatment plan to the payer before treatment begins. The payer reviews the treatment plan and notifies the dentist and patient of one or more of the following: patient's eligibility, covered services, amounts payable, co-payment and deductibles and plan maximums.”
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Does Bluecross Blueshield cover bariatric surgery?
Most BCBS plans do cover bariatric surgery, but yes, they all have varying requirements. In general, almost every plan requires and initial consult with a surgeon, a consult with a dietician, and a psychological evaluation. Some plans will have more requirements.
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What is a claim for predetermination?
Predetermination is a: Voluntary utilization management review. Written request for verification of benefits prior to rendering services*
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What is a pre-determination form for?
Predetermination of benefits is similar to pre-authorization in that it allows services and treatment to be reviewed for medical necessity. Benefit coverage is predetermined before services are rendered and any limitation under a plan can be addressed before services are rendered.
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How do I know if my insurance will pay for bariatric surgery?
You will likely have to meet some or all of the following criteria in order to get weight loss surgery covered by your insurance: Be over the age of 18 Have a BMI of 40 or greater, or have a BMI of 35 or greater with a comorbidity such as uncontrolled diabetes or hypertension Diagnosis of morbid obesity.
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What is the purpose of a predetermination?
Predetermination in healthcare is a process where your insurer's medical staff reviews recommended treatments to decide if they are necessary and covered by your plan before you receive care.
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What is the difference between a predetermination and a preauthorization?
Prior authorization confirms whether the patients have the recommended treatment covered by their insurance company or the coverage plan. On the other hand, predetermination provides detailed information like what percentage of the treatment is covered.
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How long does it take BCBS Federal to approve bariatric surgery?
In situations where bariatric surgery is considered emergent, your doctor will need to file documentation stating that and then request approval. This approval can take 3 or more days, though Blue Cross Blue Shield may approve or deny coverage within just a few days.
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