Tuesday, September 13, 2011

How do I begin the process for a follow up surgery when my insurance and job have both changed?

My son was injured when he was 3 yrs old and has multiple scars from the injuries. One is on his face and the doctors advised to follow up when he was a teenager to help with scar removal etc. I have changed jobs and insurance companies. My son is almost 16 now and has really grown in the past 2 yrs. I would like to persue the options now for his benefit and let him decide if this is what he wants to do.How do I begin the process for a follow up surgery when my insurance and job have both changed?
I am glad you have insurance coverage BUT I suspect that it will not cover a ';cosmetic'; ';elective'; procedure. You should discretely check this out.

Most probably you will need to build a case to convincingly establish that the surgery is a medical necessity.

You will need to have doctors' records that show the scars produce pain or restrict motion or have some other physical effect or that the existence of the scars is causing severe mental or emotional trauma (such as might be the case if your child were being continually teased as kids might do). When you have established the background case, approach your health insurer and ask them to predetermine that the proposed procedure will be covered and paid for.

Best wishes.

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