Has your health insurance company or HMO denied your claim for reconstructive surgery? Gianelli & Morris attorneys are aware that health plans in California such as Kaiser Foundation Health Plan, United Health Care, PacifiCare, Blue Shield of California and others routinely deny requests for reconstructive surgery even though the law requires coverage to correct or repair abnormal structures of the body to improve function or create a normal appearance. In most cases, requests for reconstructive surgery to correct an abnormal body structure are denied because the health plan improperly determines that they are cosmetic.
Abnormal structures of the body may be caused by congenital defects such as a cleft palate, trauma resulting from an accident or injury, developmental abnormalities, tumors, infection or disease. Some examples of reconstructive surgery required to correct abnormal structures of the body include:
- Correction of a cleft palate;
- Breast reconstruction following a mastectomy to treat breast cancer;
- Removal of excess skin remaining after bariatric surgery for treatment of morbid obesity.
If your health plan has denied your request for reconstructive surgery, or denied your claim for reconstructive surgery if you decided to pay for it yourself, contact us.
