Monday, July 23, 2007

Insurance Won't Pay For Breast Birth Defect Surgery

From WSET in Roanoke, Virginia:

If you pay health insurance every month, you expect the coverage to be there when you need it. One Roanoke mother is frustrated because her claim has been denied twice by her provider. Her 14-year old daughter has, what her doctor calls a birth defect. But the insurance company says the procedure the doctor wants to do is cosmetic so they won't cover it.

Dr. Briener - "I can't remember a time when I haven't had a patient covered by insurance for this type of deformity."

Doctor Briener has diagnosed his young female patient with Poland's Syndrome. That's an absence or underdevelopment of the chest muscle on one side of the body...

There is also a video of the news report that you can view on the WSET website.


crazeyk2 said...

I would ask that insurance companies re-evaluate the rationale for providing financial coverage to cancer victims for breast reconstruction and not for victims of poland's syndrome. Reconstructive surgery is to help restore dignity and improve the quality of life. As a victim of this syndrome, one struggle to maintain self esteem and a quality of life. Surgery offers hope that one can be normal. Reconstruction surgery enhances the deformity to appear normal and symmeterical under clothing depnding on the severity. However, one is never normal,as there are both physical imbalances and weakness, muscular and skeletal pain, physical scars and emotional trauma. There are constant challenges in all areas of life. Reconstruction surgery could be a life saving technique that promotes hope for some individuals. It should be categorized as standardized reimburseable treatment.

Melissa Hawthorne said...

That is so unfair to the child. I too have the syndrome yet I do not have health insurance and have no way to pay for it. Knowing what the child is going through she should write a letter to the insurance company to explain her position and her parents should find other cases where the surgery is normally deemed cosmetic but can be used as a correction. Isn't that what basic skin grafts for burn victims are?

ltlone95521 said...

I have Poland Syndrome and when I became an adult I wanted to have surgery and I was still covered by my parents insurance. They didn't want to pay for my surgery, but after writing a 2 page letter stating how this birth defect affects me emotionally, physically and how it has damaged my self-esteem. My doctor knew how much I wanted this surgery and after being denied by the insurance she had suggested the letter. Shortly after the insurance received and read it, they granted the surgery and stopped calling it cosmetic. Now, I will have to do the same thing with my insurance to have any new surgery. Now, I did all of this 11 years ago. But, if you make a big deal about how you have been affected you really should have no problem getting the insurance to cover it. But, your doctor may want you to wait until you are an adult and have finished growing and physically developing. I hope this advice has been helpful.