OT: Plastic surgery denial

alla B.
on 6/4/11 2:42 pm, edited 6/4/11 2:43 pm
Hi, I put OT beacause I have question about plastic surgery procedure and would like to ask here , I know a few people who is really good with this.
I tried to get approved for breast lift/reduction , i have Oxford and it is covered , but should be medically nessesary.
I got deniel twice from Oxford and denied from external appeal.
What is my next step?How can I appeal external denial?
Please help, I need to get rid of those huge breasts!.
Thank you.
Alla

PART 1 VSG  03/28/2006;  PART 2   DS  01/31/20007

(deactivated member)
on 6/4/11 2:54 pm - San Jose, CA
If you've had an external/independent medical review, the decision is final, unless you have the right to file a federal ERISA lawsuit - which is cost-prohibitive unless you can do it yourself.

Your only recourse is to find another reason for medical necessity - an intractable rash, for example, and start all over again with another reason.

Or self pay.

Or change insurance companies.
alla B.
on 6/5/11 11:14 pm
Thank you

PART 1 VSG  03/28/2006;  PART 2   DS  01/31/20007

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