Printable coverage questions
Keep the plan rule, clinical record, and payer response together
This checklist organizes questions and records that may matter during coverage review. The applicable requirements come from the exact plan, procedure, jurisdiction, and submitted clinical facts.
Start with the exact plan
- Current medical policy or coverage criteria requested
- Cosmetic exclusions and functional-service rules identified
- Network, referral, and prior-authorization rules confirmed
- Policy effective date and call reference number saved
Ask the treating office
- Symptoms and daily impact documented accurately
- Examination findings and procedure named
- Required clinical photographs discussed
- Required measurements or testing confirmed before arranging them
Track the submission
- Submitting clinician or billing contact identified
- Records sent and date recorded
- Authorization or claim reference number saved
- Written approval, denial, or request for more information retained
If the answer is no or unclear
- Reason and policy section requested in writing
- Correction, peer review, and appeal options requested
- Deadlines and required forms recorded
- Self-pay quote kept separate from coverage questions
Turn the checklist into a readiness matrix
The insurance readiness quiz sorts ten answers into present, missing, and confirm-later items without an email gate or hidden approval score.
Educational planning only. This checklist does not determine coverage, establish medical necessity, interpret tests, provide insurance advice, or predict approval. Confirm current requirements with the insurer and treating clinician’s billing office.
Medicare billing article: blepharoplasty, ptosis and brow lift ↗Centers for Medicare & Medicaid ServicesOne jurisdiction-specific billing article; use the database to confirm the policy that applies to the treating location.Medicare LCD: blepharoplasty, ptosis and brow lift ↗Centers for Medicare & Medicaid ServicesOne local coverage policy example; requirements vary by contractor and plan.Medicare LCD: cosmetic versus functional services ↗Centers for Medicare & Medicaid ServicesExplains that appearance-only procedures are not covered by Medicare.
“Procedures performed only to improve appearances without a functional benefit are not covered by Medicare.”Medicare Coverage Database search ↗Centers for Medicare & Medicaid ServicesUse location and policy details to find the applicable current document.Clinical Policy Bulletin 0084 ↗AetnaA commercial-payer example showing why procedure-specific measurements and documentation must be checked against the exact plan.CG-SURG-03: Blepharoplasty, blepharoptosis repair, and brow lift ↗AnthemAnother commercial-payer example; requirements and applicability vary by plan, market, and effective date.Coverage Policy 0045 ↗CignaA current public policy example. SurgeryViz does not convert its thresholds into a universal coverage rule.