So,
I asked (all through email) my insurance company, Coventry, if they cover gynecomastia surgery. They responding, saying that they need a CPT code from my doctor. I had no idea what a CPT code is, but I have a good friend at Johns Hopkins. She told me the code could be 19140, which is mastectomy for gynecomastia. I then relayed this information to Coventry, to which they replied that 19140 is not a valid code. I told my friend at Johns Hopkins, and she looked into it. It turns out that Coventry did not have any information or policies on gynecomastia. When she was done, they now recognized that gynecomastia exists, and 19140 is now a valid code (as it should be). However, they also immediately considered the surgery to be cosmetic, and as such, will not pay for it.
From the email detailing Coventry's new (first) policy on gynecomastia:
Okay, here's the story.
Coventry now recognizes the CPT Code 19140, however, unless you are diagnosed with breast cancer or a physician concludes that it is medically necessary, it is not covered under your insurance or any else's for that matter for cosmetic reasons.
So here are my questions:
- How can I make an appeal? Since I have not "officially" asked Coventry if they will cover surgery, I suppose that I have not been "officially" turned down, and thus, can not make an appeal, right?
- How do I "officially" see if Coventry will cover the surgery? Do I need to first get the surgery done, or do I ask them for pre-approval?
- How do I go about scheduling doctor and psychiatrist appointments so that I can get them to write up their appeal letters?
- In summary, what next?
--Kyle Johnson
