Insurance Denies Life-Saving Surgery, Calling It "Cosmetic"

Main Category: Health Insurance / Medical Insurance
Article Date: 22 Sep 2008 - 4:00 PDT

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"Aetna health insurance has denied me coverage to treat a disconnected jawbone and insufficient airway, which is called mandible/maxillary hypoplasia," explains Karen George of Woodbridge, Virginia. "Aetna stated they see no necessity for surgery except for cosmetic reasons despite the fact that I have medical necessity letters from six different doctors."

"A physician, who is a renowned specialist in this field, pleaded with Aetna stating that my condition is life-threatening due to a deficient airway. I am in extreme pain, take daily doses of Klonopin, Flexeril, and Lortab, but still Aetna has denied me coverage."

"The specialist stated that his proposed surgeries would drastically improve my quality of life and level of pain. Without them, I have had to undergo sedation procedures to manipulate my jaw and remove tissue growing inside the disconnected jawbone. This will continue unless I have the surgery."

"I attempted to get help from the Virginia's Bureau of Insurance, who informed me that by law my surgery has to be covered; a self-insured plan with Aetna is exempt from abiding by state and federal laws."

"This insurance denial has not only caused financial hardship on my family, but my dentist has put all my dental work on hold because I am unable to open my jaw more than 12 millimeters. I now risk the loss of all of my root canal teeth, I can't have dental cleanings, and my orthodontist can go no further in correcting my gross mal-occlusion."

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