Re: Sculptra for facial lipoatrophy & United Health Insurance

[Guest guest]

Tom, Was your letter signed by a doctor? A treating physician's medical opinion that the procedure is necessary to restore the normal contours of your face would be accorded a great deal more weight than a letter from you, the patient, saying the same thing. That being said, I think most insurance companies and HMOs are almost always denying claims for facial restoration, and won't change their ways until forced to do so by court order. Even in California, where regulations state that such treatments should be covered, claims are denied. I would still appeal, if I were you. If the appeal is read by a different person or persons, there's always a chance of prevailing. If you received a letter explaining the denial, have your doctor write another letter refuting the denial letter, answering their points, one by one. If nothing else, you'll force the insurance company or HMO to spend money defending its decision. tom harman wrote: Walter, I submitted a claim to United healthcare after I had my first Sculptra injection set. It was denied. Their reasoning was that the procedure was cosmetic. Before I had the injection, I called United and asked them if it would be covered. The person I spoke to could find no reference on Sculptra and had no idea what I was talking about. So I tried to get reimbursed after being unable to get any kind of pre-approval.

When I submitted my claim, I included a letter that referred to my procedure as re-constructive (and included many of the items included in 's sample letter on his website; I took his letter and modified it a little) and still they denied it. I've been thinking about appealing the claim denial but have yet to come up with an angle. If you come up with anything let me know. Thanks. Walter Nolting wrote: Has anyone had any experience with United Health Insurance and Sculptra for facial lipoatrophy. I am looking for people that have been approved or denied by United Health Insurance.I have lipoatrophy of the face and want to approach United Health Insurance to cover the cost of Sculptra for facial lipoatrophy. If I can find someone that they have

covered this will make it easier for me to make a case. I will let the group now when I have had success so others that have United Health Insurance can follow the procedures I had to take.Thanks for your time and help. Want to be your own boss? Learn how on Yahoo! Small Business.

[Guest guest]

Talking about a court order, it is a shame that Lambda Legal Defense

which brags all the time about how much they serve the HIV positive

community has not taken on the cause to have treatments for

lipoatrophy and lipohyperthropy to be accepted by health insurance

companies as reconstructive surgery. It is only due to prejudice

and bias can the companies deny coverage for these reconstructive

procedures, while they routinely approve breast reconstructive

surgery for cancer. Only by continuous contacting and urging by

people who donate to Lambda Legal Defense, will they change their

posture. I wonder if this group is up to a concerted effort to get

them to take on a test case so that a precedence can be established.

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> Tom,

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> Was your letter signed by a doctor? A treating physician's

medical opinion that the procedure is necessary to restore the

normal contours of your face would be accorded a great deal more

weight than a letter from you, the patient, saying the same thing.

That being said, I think most insurance companies and HMOs are

almost always denying claims for facial restoration, and won't

change their ways until forced to do so by court order. Even in

California, where regulations state that such treatments should be

covered, claims are denied. I would still appeal, if I were you. If

the appeal is read by a different person or persons, there's always

a chance of prevailing. If you received a letter explaining the

denial, have your doctor write another letter refuting the denial

letter, answering their points, one by one. If nothing else, you'll

force the insurance company or HMO to spend money defending its

decision.

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