• Appealing a Denial of Your Plastic Surgery Procedure

    Your health insurance company may deny, or not authorize, your plastic surgery procedure. You will usually get a letter in the mail confirming this denial. If this occurs, then you may want to appeal this decision.

    Before making an appeal, get your health insurance benefits booklet or go to the website. There may be exclusions in your specific health care plan that legitimately excludes the type of care or procedure you want to receive.

    If you can go forward with your appeal, make sure you have all of the paperwork involved, and specifically the denial letter. Your denial letter may have information on it that explains how you can appeal the denial decision. The first step is usually writing a letter to your health insurance company, often the claims supervisor who signed your denial letter. Your letter should explain why you feel that your procedure should be covered, and you should ask that your request be reviewed by a plastic surgeon certified by the American Board of Plastic Surgery. You should also ask for a full explanation as to why your procedure is being denied.

    You can request for the specific words or text from your benefits booklet explaining why your procedure is denied. You should be firm in requesting very detailed, specific language, and not a vague or general denial.

    You can look at position papers at this link, from the ASPS/ American Society of Plastic Surgeons- http://www.plasticsurgery.org/Patients_and_Consumers/Procedures/Reconstructive_Procedures.html

    With your letter, also send in a copy of your denial letter. A letter from your plastic surgeon may also help.

    Unfortunately, it may need to be patient and wait for a response. Insurance companies are known for their bureaucracy, so don’t expect a quick answer.

     

    Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

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