This year I applied for my insurance to cover my breast reduction. I am a 20 year old female, 4'11", 135lbs and wear a 36G. My breasts themselves are really heavy, visibly uneven and have caused quite the wear on my back. The plastic surgeon I went to recommended that we remove approximately 600-700 grams of tissue from my breasts. All this information was sent to Horizon and they still denied it. Is it worth appealing and if so, what do I need to have them approve it?
September 30, 2015
Answer: Insurance coverage in breast reduction. Whether or not sure insurance company will cover breast reduction is uncertain even with the previous denial. Many insurance companies deny any claim the first time it comes through the door. Certainly an appeal would be worth it but don't count on the insurance company to reverse its initial decision.
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September 30, 2015
Answer: Insurance coverage in breast reduction. Whether or not sure insurance company will cover breast reduction is uncertain even with the previous denial. Many insurance companies deny any claim the first time it comes through the door. Certainly an appeal would be worth it but don't count on the insurance company to reverse its initial decision.
Helpful
November 9, 2015
Answer: When is insurance not insurance? I have been told by industry insiders that some insurance companies' first rule of defense is to deny the first request for pre-authorization, hoping that you will be discouraged and simply blow away. Read your policy and determine if breast reduction is a covered procedure for treating macromastia. If covered, you should qualify, but insurance companies prefer to keep their own enigmatic criteria for approval confidential, so it's anyone's guess as to why they may deny you coverage. Appeal, call them, write letters, and be a nuisance. But in the end, as much as I hate to say it, a brief letter from an attorney may unlock the gate.
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November 9, 2015
Answer: When is insurance not insurance? I have been told by industry insiders that some insurance companies' first rule of defense is to deny the first request for pre-authorization, hoping that you will be discouraged and simply blow away. Read your policy and determine if breast reduction is a covered procedure for treating macromastia. If covered, you should qualify, but insurance companies prefer to keep their own enigmatic criteria for approval confidential, so it's anyone's guess as to why they may deny you coverage. Appeal, call them, write letters, and be a nuisance. But in the end, as much as I hate to say it, a brief letter from an attorney may unlock the gate.
Helpful
