My ENT/ facial plastics specialist has been fighting with my insurance company since December to get my rhinoplasty covered and even though I have met all the criteria stated in my benefits book they continue to deny it as cosmetic. He has requested a peer to peer review but he and his nurse continue to get the run around and have been unable to schedule it. Is there anything I can do or any foundation who helps people who need reconstruction due to disease?
Saddle Nose Reconstuction Due to Wegener's Granulomatosis. What Can I Do To Help Others With The Same Disease? (photo)
Doctor Answers (2)
Call your insurance company directly.
In California, denial of this service might constitute first party bad faith on the part of the insurance company-subject to significant financial penalties. If your health insurance is provided through work, discuss the situation with human resources. Many larger employers are actually self-insured with the plan simply administered by the health plan. Getting a push from the employer to cover the service may get the insurance company moving. Consider contacting the insurance commissioner in your State. Get names and titles of anyone you speak with and don't take no for an answer. Let the insurance company know that you are considering setting up a website to document there lack of coverage. Be a squeaky wheel.
SOmetimes having a second doctor write a letter for you may help
If you continue to have problems after the peer to peer review you may consider getting a second consult from another surgeon who can then also back up your surgeons notes.
Hope that helps.
Peyman Solieman, MD
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.