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United Healthcare Denied Coverage!!!!

United Healthcare Denied Coverage!!!!

Postby MichC » Tue Sep 15, 2009 10:00 am

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 :(
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Postby soontobesmaller » Tue Sep 15, 2009 11:13 am

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

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Exclusion

Postby MichC » Tue Sep 15, 2009 11:57 am

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 :(
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Postby soontobesmaller » Tue Sep 15, 2009 2:17 pm

It sounds like they are only providing coverage for reconstructive surgery after cancer breast removal. I wonder if there is anything under back and neck pain that would cover it?
4' 11" 127 lbs 57 yrs old Was Size 34H hoping to be a 34B or C

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Postby dink2061 » Tue Sep 15, 2009 2:22 pm

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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Postby ohmama222 » Tue Sep 15, 2009 8:15 pm

WOW!! I am so surprised to here that. There has got to be a loop hole. :?
5'4" 41 YRS OLD
SURGERY DATE 8/17/09
BEFORE BR 42 F
NOW 40 C (HOPEFULLY)
FROM MICHIGAN
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Dnial

Postby MichC » Wed Sep 16, 2009 6:02 am

So Dink 2061 what did you do? Did you pay for it yourself or did you fianlly get it covered?

I found a court case where a woman had this exact situation and the court found in her favor! I plan on using that as documentation for my appeal.
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Postby drdisaia » Mon Sep 21, 2009 7:39 am

Hello,

I am posting to my blog on this today. Specific policy exclusions for breast reduction are something I haven't seen before.
Best Regards,

John Di Saia MD * Breast and Body Contouring
Orange County, Ca
Tummy Tuck http://psinteractive.net/abdex.htm
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