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I am so upset. Surgeons office just called me to say that United has denied coverage because there is an exclusion in my pilicy for Breast Reductuons. I had called United twice previous to going for consults and was told this was covered over the phone. Now they say there is an exclusion. Has anyone encountered this?? Any advise??? I feel devasted. I was sure it would be covered after being told so over the phone. i just can't believe this
Please ask for the exclusion in writing. They will tell you breast reductions are excluded, but they should only excluded if not medically necessary. Once you get the verbiage, you can take action to meet their criteria. I have heard of policies where breast reductions are excluded even if proven medically necessary. I say I've heard that, but I've yet to see one be true. Keep at it. You may still qualify, but you may be like me and have to jump through some hoops first.
4' 11" 127 lbs 57 yrs old Was Size 34H hoping to be a 34B or C
The Exclusion is listed under the catagory of "Physical Appearance" and says "Breast Reduction except as coverage is required by the Women's Health and Cancer Right's Act of 1998. " Now obviously this won't apply because I don't have cancer BUT the fact that the exclusion is listed under "Physical Appearance" seems to me that it should not apply to a medically necessary treatment. Now how I prove that and go about convincing the insurance company of that is the challenge
United Healthcare denied me as well. Basically, because I didnt get rashes. I had multiple dr's letters, documented back surgery, recent MRI and Xrays showing degenerative disc disease and so on and so on. My PS said they were THE WORST for getting coverage.
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