Winning Insurance Appeals For Patients!

RECONSTRUCTIVE SURGERY DENIALS

In 2011, at its annual conference, a study presented to the American Society of Plastic Surgeons (ASPS) (www.plasticsurgery.org) found that 75 percent of post-bariatric patients in the study were not informed of the body contouring options available to them. That lack of awareness and cost considerations were cited by patients as the main reasons for not having reconstructive surgery. That study showed nearly one third were unable to afford such procedures due to a lack of insurance coverage as they are often considered cosmetic in nature.

Although the outward effects may be similar or even identical, the terms cosmetic and reconstructive surgery are not interchangeable. The American Medical Association (AMA) adopted these definitions of “cosmetic” and “reconstructive” surgery in 1989:

  • Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient’s appearance and self esteem.

  • Reconstructive surgery is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance.

We can help appeal denials of medically necessary reconstructive surgery in appropriate cases.

601-C East Palomar Street #480 Chula Vista, California 91911 Tel - (619) 656-5251 Fax - (888) 992-1188