Cosmetic Versus Medical Surgery

[Lawrencewendall]

Not sure if this is the right place but here goes.

Several years ago my DW had nose surgery for a deviated septum. She goes into the ENT this week due to sinus problems. They tell her the previous surgery collapsed her nostrils which is causing her current issue. Our primary care doctor says the surgery to fix the problem is cosmetic surgery and will not be covered by our HI. How is this possible for surgery to correct a medical problem? Maybe it will be done by a plastic surgeon but it's still for a medical condition. Anyone have input? I'm baffled.

 

[Meadbh]

Of course it’s not “cosmetic”. I think DW should get a second opinion.

 

[Sunset]

Of course it’s not “cosmetic”. I think DW should get a second opinion.

^^^^^^^^^ - believe Meadbh as he knows his med stuff

 

[Sarah S]

Absolutely. That is ridiculous. Plastic surgeons do many medically necessary surgeries and they are covered by insurance. The plastics know how to bill and get PAs if needed.

Do you need a referral from the pcp? If you don't just ignore him/ her and talk to the surgeon. If you do need a referral and can't get it call your insurance company and complain and get the ENT to document need.

If your pcp told you this and not a member of the staff consider a new pcp.

 

[kcowan]

I agree with meadbh. However, the original operation was probably coded as cosmetic and this one is to correct that. So there is some wiggle room for the stingy insurance co.

You need to know whether that is the basis for their decision.

 

[Meadbh]

^^^^^^^^^ - believe Meadbh as he knows his med stuff

This is Meadbh, and I Am Woman!!!!

 

[Meadbh]

I agree with meadbh. However, the original operation was probably coded as cosmetic and this one is to correct that. So there is some wiggle room for the stingy insurance co.

You need to know whether that is the basis for their decision.

Keith, correction of a deviated septum is done to alleviate nasal obstruction, which can lead to impaired breathing and sinus infections. It is definitely NOT cosmetic. The results cannot be seen from the outside. My father had this surgery about 1978, and he was not the type of man to undergo cosmetic surgery!

 

[braumeister]

This is Meadbh, and I Am Woman!!!!

LOL!
Irish names can be difficult. Ask anyone named Pat.

 

[Meadbh]

LOL!
Irish names can be difficult. Ask anyone named Pat.

As it happens, my real name is quite ambiguous. But Meadbh was a mythological Irish Queen. Very much a female!

http://www.queenmaeve.org

Now back to our regularly scheduled programming......

 

[ivinsfan]

This is Meadbh, and I Am Woman!!!!

I was pretty certain you were of the female persuasion

 

[MichaelB]

This is Meadbh, and I Am Woman!!!!

 

[Sunset]

This is Meadbh, and I Am Woman!!!!

Oops sorry, I didn't look at your profile before posting, if it's even noted there ?
(I looked after posting this, and it's not).

As for the name, I don't even think of the user names as real, and since I read further down the thread I can see it's not.
I don't know all the mythical creatures of the world, nor even the real ones, so I had no clue from the name.
I am sorry if you took offense, feel free to call me a she anytime.

 

[Senator]

That should be medical.

There are many surgeries that seem to be cosmetic, but are granted to be medical. Any surgery to help your mental health and well being, would be medical. I have seen several as a landlord that would boggle people's minds.

 

[Meadbh]

Oops sorry, I didn't look at your profile before posting, if it's even noted there ?
(I looked after posting this, and it's not).

As for the name, I don't even think of the user names as real, and since I read further down the thread I can see it's not.
I don't know all the mythical creatures of the world, nor even the real ones, so I had no clue from the name.
I am sorry if you took offense, feel free to call me a she anytime.

I used to have a more detailed profile, but I pared it down for privacy reasons. No offence taken!

 

[harley]

I'm not quite sure that's the line from the song that should be highlighted for most personages of the female persuasion.

 

[Jerry1]

There is no point in taking the opinion of your PCP on this. Go to the surgeon and have them get pre approval from the insurance company. If the procedure is classified as cosmetic, there are appeal rights. I doubt you will have any difficulty. As was mentioned, medical staff know how to bill correctly and legally which should be all you need. Your PCP is not a biller and not a surgeon.

 

[Bamaman]

Plastic surgeons have to pay the bills with cosmetic surgeries so they can get to do the surgeries caused by injuries. Unfortunately, dealing with some plastic surgeons is like dealing with an artist. They can be somewhat self centered and egotistocal.

 

[braumeister]

I'm not quite sure that's the line from the song that should be highlighted for most personages of the female persuasion.

OTOH, I think women generally tend to be better investors than men, so on this board it might be appropriate.