Medical Exempt Status
Medically exempt includes the following criteria:
- Disabling mental disorder (including adults with serious mental illness)
- Chronic substance abuse disorders
- Serious and complex conditions
- Physical, intellectual, or developmental disability that significantly impairs an individual's ability to perform one or more activities of daily living
- Disability determination based on Social Security criteria
This form will need to be filled out per your primary care provider and submitted back to your insurance for review and confirmation of change in status to “Medical Exempt.”
Medically Exempt Form 470-5198
Please contact Mercy’s Financial Navigator at (319) 369-4520 approximately one to two weeks after you have submitted your form back to your insurance. The Financial Navigator may be able to determine if you have been approved for Medical Exempt Status.
Entry into Mercy’s bariatric program is placed on hold during this process until a Medical Exempt Status is confirmed. This includes the review of the bariatric questionnaire, as well as scheduling appointment(s).
