Question:
2 Denials for Reconstructive Surgery - Retained an Attorney - HELP!
I have been denied twice for reconstructive plastic surgery, specifically, hernia repair with abdominoplasty, and brachioplasty with thighplasty. <b>I AM INFURIATED!!</b> I meet all the requirements for "reconstructive vs. cosmetic", and have all the medical problems that document plastic surgery as medically necessary provided by three different plastic surgeons, my PCP, my OB/GYN, and my bariatric surgeon. To add fuel to the fire, a coworker upstairs had an abdominoplasty covered three years ago. No changes in the plan.<br><br>So, I have retained an attorney. I want to be cautious, however, because I don't want to wind up spending as much in attorney fees as I would by paying out of pocket for the surgeries. I have a preference for one surgeon, but if I can't get it covered by insurance, I'll have to go with my second choice due to cost. Another kink, is I have only TWO times available this year due to my hectic schedule with family, grad school, and work.<br><br>If anyone can give me some additional tips on what else I could <b><i>POSSIBLY</i></b> provide to have this overturned as quickly and as cost-effective as possible. Many thanks in advance. — [Deactivated Member] (posted on April 24, 2001)
April 24, 2001
What does the denial specifically say? Is it that they wont cover all or
just one piece they don't like etc? How abotu trying to auth each
procedure separately like was stated above... If you meet the requirements
then something else is going on and your denial should state exactly what
that is. Holler if I can help at all.
— Dawn R.
April 24, 2001
Additional info: Neither I nor my surgeon have received written
documentation of either denial. Quite convenient, given I have no right to
sue until I receive it. The procedures were requested to be done
separately. All they will tell me is that is isn't medically necessary.
— [Deactivated Member]
April 24, 2001
Check w/ your state insurance comissioner and find out what your rights
are.. you have to get the denial in writting.. this makes no sense. Not
only do you have a right to get that information you should also be able to
find out what their criteria is specifically. I'll try to help in anyway I
can let me know what I can do!
— Dawn R.
March 19, 2007
You should have the financial responsiblity for your own cosmetic surgery.
but for the fact you were not formerly obese you would not need these
procedures. Therefore, you ultimately are responsible for the shape your
body is in now and not others. who pays for your grad school?
— careforyou
May 7, 2007
I don't agree with the one poster that you should pay because you were
formerly obese and caused that obesity. What if the insurance would not
cover plastic surgery for a skin cancer on your face, for instance, saying
that if you had stayed out of the sun you would not have caused the
deformity resulting from removal of the skin cancer. No, insurance is
responsible to pay if they state in the policy that they will pay based on
certain criteria. If a coworker had the same thing done, then I would find
out what the difference between me and the coworker to see if there was
something more I needed to do to be qualified. Insurance companies
certainly can't pick and choose who they allow to cover if the policy
states clearly what it will cover.
— Sharon J.
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