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.

ACA Survey of Prosthetic Coverage Restrictions

The Amputee Coalition of America has released a survey that found a wide disparity between what private insurers will cover for prosthetic devices. The ACA is advocating at the state and federal level for legislation that requires all private health insurers to provide coverage for the "fitting, repair or replacement of a prosthetic device and/or component."

ACA Legislative Agenda

The Amputee Coalition of America is pushing legislation in 21 states in 2007 that would require insurers to provide coverage that allows policyholders to receive the prosthetic device they need. Here's how ACA frames the issue:

"In return for premiums paid for group health insurance, consumers expect to be covered for catastrophic illness or injury. Sadly, without legislation to ensure coverage, many people living with the loss or absence of a limb are facing discouraging obstacles when trying to obtain prosthetic care. Current changes in insurance plans are having a devastating effect on amputees and their families..."

The Coalition's online advocacy center includes a wealth of information on the issue and this initiative, including the status of legislation or coalition building in each state. The organization is also maintaining a blog specificly focused on its legislative campaigns. In a previous post I highlighted an upcoming volunteer night in DC that will help support the overall legislative effort. For more information on these efforts you can contact the ACA's Advocacy Dept. at (202) 742-1885 or appll@amputee-coalition.org.

ACA Volunteer Night in DC

The Amputee Coalition of America is organizing a "volunteer night" in DC on Wednesday, January 17th. According to the ACA advocacy page, the organization is pushing for prosthetic insurance legislation in 21 states in 2007 and is looking for volunteers to help support that effort. For more information you can contact Jeremiah at (202) 742-1885 or jperez@amputee-coalition.org.