Question:
Turning a denial into coverage even with a policy exclusion for plastic surgery?

Has anyone been able to change a denial of coverage for plastic surgery even with a policy exclusion stated?? I need all the help I can get!! Thanks!!    — dixie24fan (posted on October 20, 2004)

October 20, 2004
Jeanie, send me an e-mail and I will send you my appeal letter. My policy specifically excluded panniculectomies and similiar surgeries after WLS. I got my abdominoplasty covered. I don't know if that will help, depending on what plastics you are looking at.
   — koogy

October 25, 2004
Some policies exclude "plastic surgery" but they usually define it as a surgery "solely to improve the appearance of the body" i.e. cosmetic. This can be overcome by proving that you in fact have medical problems from the excess skin, etc. Speific procedure exclusions, like breast reduction, LASIK, and others, are nearly impossible to defeat, simply because that's the contract and you signed it.
   — DrL