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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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Breast
augmentation difficult to justify to insurance company
Jan. 16, 2004
Q:
My 17 year old daughter has uneven breast development.
She has had hormone tests. Nothing is wrong other than
the size disparity. The size difference is readily noticeable.
One side is probably a C cup. The other side is nearly
flat. She will not wear a bathing suit. I know this
affects her self-esteem.
During
her last physical I asked the doctor about having surgery
to correct the problem before she goes away to college.
The doctor stated that because there was nothing physically
wrong, it would be considered cosmetic surgery. Therefore,
the insurance company would not pay for it.
My
daughter once described herself as a "freak."
I know this is hard for her to deal with. Do all insurance
companies feel this way? We could change insurance companies.
I think of this as corrective surgery, not cosmetic.
Am I way off target?
A:
You probably will have difficulty in finding an insurance
company to pay for either a breast reduction or breast
augmentation when there is no physical problem. Most
insurance companies will view this as cosmetic surgery.
You
may want to consult with a surgeon who has experience
with this kind of surgery. Ask him about insurance coverage.
Perhaps he has noticed that some companies will cover
the surgery for problems similar to your daughter's.
He may be able to make a recommendation to you. Keep
in mind that if you switch insurance carriers at this
point, the new insurance may consider your daughter's
condition as pre-existing. This could be another issue
you would have to deal with.
You
may also want to contact a psychiatrist. I do not know
if this surgery could be covered with a psychiatric
diagnosis. Your daughter is distraught and has low self-esteem.
Some insurance companies may cover conditions that pose
a mental threat to someone's well being. You might want
to look into this.
You
can talk to most insurance companies in advance of the
procedure and ask them to review your case for coverage.
The insurance company may request surgeon's notes and
want the psychiatrist's notes. They may review your
daughter's individual case and make a determination
for coverage before she has any surgery. This way you
would know in advance about coverage and there will
be no surprises.
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