insurance and gyno?

[jedi786]

hey i have fairly good health insurance in that states and i was wondering, what are the chances of insurance taking care of the gyno operation? thanks

[headheldhigh01]

something close to a snowball's chance in hell.  there have been exceptions, but they usually try to claim it's merely cosmetic.  it's an often discussed subject here, you could find lots of threads by plugging "insurance" into the site search engine.  sometimes people can make a case when there's been strong physical pain, and there was an interesting new york case that ruled against the insurance company, so you can try, but it's still usually unsuccessful.  (nice handle btw).  

[Paa_Paw]

HHH covered it so well that I really have nothing to add beyond welcoming you to the site.

[KAG]

You got a better chance of having a snowball fight in hell.

[myth77]

You got a better chance of having a snowball fight in hell.

You just said what HHH said -.-

[fluffy_tits]

I read somewhere on this forum that somebody got insurance and he told who he did it to so you should look for that and see if you can follow his instructions.  But mostly like it's a 1% chance but there's stilll that one 1 percent!!  Good luck!







Fluffy( o )v( o )...

[Paa_Paw]

Most medical insurance policies are selected on the basis of cost.

In order to keep costs down, the policies have long lists of things that are not covered.

Unless you have a very costly policy, breast reduction surgery is probably excluded except in the presence of pathology such as breast cancer. Such conditions are possible in men, but they are quite rare.

[Legion267]

I've been insured with United Healthcare for a couple of years. I recently looked up some information on their website and am still a bit confused as to whether or not there is a chance they may approve a claim. This is what they list at their site...

Reconstructive Procedures are services performed when the primary purpose of the procedure is either to treat a medical condition or to improve or restore physiologic function for an organ or body part. Reconstructive procedures include surgery or other procedures which are associated with an Injury, Sickness or Congenital Anomaly. The primary result of the procedure is not a changed or improved physical appearance

Cosmetic procedures are excluded from coverage. Procedures that correct an anatomical Congenital Anomaly without improving or restoring physiologic function are considered Cosmetic Procedures

 

The fact that a Covered Person may suffer psychological consequences or socially avoidant behavior as a result of an Injury, Sickness or Congenital Anomaly does not classify surgery (or other procedures done to relieve such consequences or behavior) as a reconstructive procedure

 

Note: See exclusions described under Physical Appearance.

Under exclusions this is what I found...

Cosmetic Procedures including, but not limited to, pharmacological regimens; nutritional procedures or treatments; salabrasion, chemosurgery and other such skin abrasion procedures associated with the removal of scars, tattoos, and/or which are performed as a treatment for acne. Replacement of an existing breast implant is excluded if the earlier breast implant was a Cosmetic Procedure. (Replacement of an existing breast implant is considered reconstructive if the initial breast implant followed mastectomy.)
Physical conditioning programs such as athletic training, bodybuilding, exercise, fitness, flexibility, and diversion or general motivation. Weight loss programs for medical and non-medical reasons. Wigs, regardless of the reason for the hair loss.

Is there a good chance that I might get them to cover the surgery if I and a doctor claim that it would also improve my physical condition?

[Dr. Elliot Jacobs]

Insurance companies write their own policies and make the policies specifically vague enough to give themselves great leeway in interpreting what will be covered.  And since they would have to pay for you, they are most reluctant to be generous in an interpretation about gyne surgery.

You can certainly try the route of "improving a physical condition" -- my sense is they will ignore it.  And unfortunately, a doctor's letter bears no weight in their decision.

And if you are unhappy with their decision, you can appeal -- to a higher person in the SAME COMPANY.  Do you think you will be successful in your appeal?  Unfortunately, they are in the driver's seat.

Dr Jacobs