Supplemental Insurance denying claim??

arissasmom

Hello all!! I am currently going through reconstructive surgery and had my I believe 5th round of fat grafting. We have supplemental health insurance through Combined, so I submitted a claim. They called me yesterday to let me know they will probably be denying the claim as it is "just cosmetic." In looking through their policy - they clearly state under "Exclusions" - cosmetic surgery unless the surgery is to correct the affected area due to trauma/disease/etc. Furthermore, they covered the lumpectomy, 2nd lumpectomy to get clear margins and the first 4 fat grafting surgeries. This is THE SAME SURGERY they covered multiple times!! I'm so confused. Do I have any recourse?? TIA!

Golden01

All group insurance plans have been required to pay for reconstruction and other similar costs following surgery for BC since 1998. Sometimes it is a problem with how your PC coded things on the claim. I'd start with them.

Here is some info that might be helpful: http://www.breastcancer.org/treatment/surgery/reco...

arissasmom

Thanks Golden01 for your response!! I guess my questions arise since they are a secondary insurance provider - are they governed by the same laws etc as "real" or primary insurance companies? I feel like I'm missing something here - how can they be so stupid as to not know their own policies?? The lady on the phone said "if it's just because they're not the same size, well that doesn't matter and it becomes cosmetic." How very offensive.