Author Topic: Insurance doesn't want to pay  (Read 3856 times)

Offline Seattle000

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My insurance company declined to pay for my surgery claiming that it's a cosmetic procedure. I was also told that my gynecomastia is moderate. What are some arguments that I can use to argue the case with my insurance company. The only reason I want to go with the surgery is because living with gynecomastia is emotionaly draining. Has anybody been able to successfuly use this as an argument?

Offline Finrod

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http://www.gynecomastia.org/content/letters/00041001.shtml

That may help, it's the story of a mother who fought with the insurance company and finally got it to cover the operation, you might want to take a look at it.

Offline Grandpa Bambu

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  • 31 Year Gynecomastia Victim...
Yes, agreed, Gyne is emotionally and psychologically painful/draining. However, insurance companies in most cases do not want to recognize/pay out on a claim as a result of most 'psychological' issues. It's not fair at all but that's just the way it is. What is all comes down to is our happiness and piece of mind right? Well, insurance companies don't give a rats @ss about our 'happiness'. Most unfortunate!  >:( :'( >:(

Good luck with battling your Ins. Co. Dig in for a long one Dude! With much persistance, you may 'persuade' the 'thievs' to cover your surgery.
« Last Edit: February 23, 2005, 07:24:50 AM by Bambu »
Surgery: February 16, 2005. - Toronto, Ontario Canada.
Surgeon: Dr. John Craig Fielding   M.D.   F.R.C.S. (C) (416.766.8890)
Pre-Op/Post-Op Pics

Offline Paa_Paw

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The letter that Finrod cites is great!  There are also news stories about recent court cases where insurance companies were sued and made to cover the surgery.

You'll need a supportive letter from a psychologist for a beginning,  and you'll need to do some homework.  But, it can be done.

Keep in touch,

Good Luck.
Grandpa Dan

Offline Seattle000

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Is it recommended that I see the psychologist before the surgery, or is it ok if I first have the surgery done and then go to the psychologist? I want to avoid delaying the surgery as much as possible.

Offline Paa_Paw

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If you see the psychologist first, it may be possible to get the surgery reconsidered and covered by the insurance to begin with.  

If you go for the surgery first, You will need to pay cash and hope for a reimbursement from the insurance which will probably put you at a disadvantage since they have already turned you down.

It is a gamble either way but going to the Psychologist first would seem to tilt the odds a bit more in your favor.

Why the rush?   What is your age?


 

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