Question:
Need help understanding Plastic Surgery Exclusion

SOMEONE PLEASE TELL ME WHAT THIS MEANS, My plastic surgeon has faxed off the predtermination letter to my insurance company for a pannielectomy. I have United Health, we finally got our new insurance books today and this is what it says about reconstructive surgery--This is under General exclusions and Limitations--they flat out deny the abdominplasty--the it says "cosmetic or reconstructive surgery or treatment. (this is surgery or treatment primarily to change ones appearance) It does not matter whether or not it is for psychological or emotional reasons..Does this rule out a pannilectomy too? I am confused any answers would be greatly appreciated..thanks    — tylerswife (posted on August 4, 2003)

August 4, 2003
It doesn't even rule out the abdominplasty UNLESS it is for appearances sake. If you have rashes or any other medical reason for having it removed (for example, mine throws my balance off and causes structural problems - back and hip trouble) then it is not for cosmetic or appearances - it is a medically valid procedure.
   — [Deactivated Member]

August 5, 2003
Insurance companies like to use very loose intrepretations of exclusions, for the lay person it appears that it is denied, but what they don't tell you is if it is medically necessary the treatment/procedures are usually covered. Like Ruth Said, it has to be MEDICALLY NECESSARY and cause problems.
   — Jeana S.