How Does Insurance "Approve" Medical Records for DS?
How does insurance “approve” medical records for DS? What exactly, are they looking for to place their seal of approval on it? What are the criteria?
For instance, if someone were to submit a claim for a WLS revision to DS, then the insurance company would be looking for what in the medical records?
Do they want to see a steady increase in weight? Do they want to see weight go up and down? What are the parameters they are looking for in order to approve a DS revision?
I’m assuming there is a claim specialist or computer sitting at a desk somewhere looking for specific numbers. What are those numbers?
I imagine they are looking for other things, too, like compliance with existing WLS. So, anybody that admits that they, in a 1/2 decade, had an after dinner mint will be considered non-compliant and rejected? I honestly don’t know.
Is there anybody that has gone through a revision that can help with what they were told by their insurance company, or that they figured out on their own, were “do’s” and “don’ts” on their successful road to revision? How can someone best prepare to give the insurance company what it needs for a successful approval for a revision to DS?
So rather than looking to the specifics of your own cir****tances, read the policy, or potential future policy, for guidance. At least that's a good starting place. If revision wls is covered, THEN you need to consider whether or not you still meet the NIH criteria, etc.
Larra
Like others mentioned, some policy's have a once in a lifetime. Others have revisions for specific reasons. It really varies. It also varies by what state you are located in. I do not see where in the US you live. California for example has an excellent record of the insurance commission turning over refusals to approvals.
Ginger<><
Revision #2 Dr John Rabkin June 21, 2013; First Revision DS - Dr Maguire 5-18-09; First DS 7-15-2003 Dr Clark Warden = Third time is the charm