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Orthographic Surgery Pre-authorization Form Instructions Patient: Print form and give to your Dentist/Orthodontist to completeDentist/Orthodontist: Fax completed form, cephalometric tracings and notes
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How to fill out orthognathic surgery prior-authorization form
How to fill out orthognathic surgery prior-authorization form
01
To fill out the orthognathic surgery prior-authorization form, follow these steps:
02
Obtain the prior-authorization form from your insurance provider or download it from their website.
03
Fill in your personal information, including your name, address, contact number, and insurance policy details.
04
Provide details about your orthognathic surgery, such as the date of the planned surgery, the name of the surgeon, and the hospital or facility where the procedure will take place.
05
Attach any supporting documents required by your insurance provider, such as diagnostic reports, X-rays, or letters of medical necessity.
06
Include information about any previous treatments or procedures related to your orthognathic condition.
07
Review the completed form for accuracy and completeness before submitting it to your insurance provider.
08
Keep a copy of the filled-out form for your records and submit the original form either electronically or by mail to your insurance provider.
09
Follow up with your insurance provider to ensure that they have received and processed your prior-authorization request.
10
Be prepared to provide additional information or clarification if requested by your insurance provider.
11
Wait for a response from your insurance provider regarding the approval or denial of the orthognathic surgery prior-authorization.
Who needs orthognathic surgery prior-authorization form?
01
Orthognathic surgery prior-authorization form is required by individuals who are planning to undergo orthognathic surgery and want their insurance provider to cover the costs associated with the procedure. It is typically needed by patients who have dental or skeletal abnormalities affecting the jaw, such as malocclusion, underbite, overbite, or facial asymmetry. The form helps the insurance provider assess the medical necessity of the surgery and determine if it meets the criteria for coverage under the patient's insurance plan.
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What is orthognathic surgery prior-authorization form?
Orthognathic surgery prior-authorization form is a form that needs to be completed and submitted to an insurance company for approval before undergoing orthognathic surgery.
Who is required to file orthognathic surgery prior-authorization form?
Patients who are planning to undergo orthognathic surgery are required to file the prior-authorization form.
How to fill out orthognathic surgery prior-authorization form?
The form must be filled out with personal and insurance information, as well as details about the surgery and medical necessity.
What is the purpose of orthognathic surgery prior-authorization form?
The purpose of the form is to obtain approval from the insurance company to cover the cost of the orthognathic surgery.
What information must be reported on orthognathic surgery prior-authorization form?
The form should include patient's personal information, insurance details, surgical procedure information, and medical necessity documentation.
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