Insurance company ordered to pay for surgery

June 2007
Same-Day Surgery;Jun2007, Vol. 31 Issue 6, p68
Academic Journal
Group Health Inc. has been ordered to reimburse a father $5,000 for his teen son's gynecomastia surgery after the insurer refused to pay on the grounds that it was a cosmetic procedure. To be successful in overcoming insurance objections to coverage of reconstructive procedures: • Send documentation, including photos and letters from other physicians, indicating the extent of the patient's condition. • Have the patient or family talk to their employer's human resources representative. • Considering publicizing the case through media stories or legal action.


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