Getting insurance coverage without medical need?

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ekrobins3
Posts: 6
Joined: Thu May 17, 2018 11:43 am

Getting insurance coverage without medical need?

#1 Post by ekrobins3 »

I am waiting to hear from my OS's office to see if my insurance will approve SARPE surgery. I am wondering, since I don't have a specific medical NEED for the surgery (I have a crossbite, but it doesn't cause me any issues, I'm 38 years old and have lived just fine with it), is it going to be hard to get insurance approval? I'm with Kaiser, if that matters.

Even when I went in to get the referral just to see the OS, my regular medical Dr was like, "well... I'll give you the referral but don't be surprised if you get a call from someone about it since you're not having any actual medical issues".

I'm nervous that I'll be anticipating for a long time, just to be denied. :-/

snapdresser
Posts: 913
Joined: Wed Feb 18, 2015 7:31 am

Re: Getting insurance coverage without medical need?

#2 Post by snapdresser »

If you don’t have a medical need, then it’s considered “cosmetic” and is thus categorically excluded from insurance coverage by virtually every health insurance policy in the US. They can put in for coverage but unless they come up with an explanation for why it’s medically necessary for you, it will be denied. Sorry :(
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