Health insurance doesn’t always buy healthcare
Re “Patients lose in insurers’ games,” Column, April 18
David Lazarus tells of the ordeal a young female patient and her doctors went through to have breast reduction surgery covered by insurance, only to be denied.
In the 1980s, I worked in a unit that reviewed appeals of medical claims denied under the group policies issued by my company. Many of the denied claims were for breast reduction. We reviewed these appeals carefully, as we recognized that the term “illness” included physical pain or limitation caused by something other than disease or injury.
In filing the appeal, the surgeon would submit evidence of the problem, which would then be referred to a medical advisor in the appropriate specialty for advice. If the advisor agreed that the surgery was appropriate, we would pay the claim.
What has become of fairness and rationality in the medical insurance industry?
Fred Dean
Los Angeles
Lazarus points out problems that arise when interpreting an insurance policy.
Before signing up with any insurance company, it is advisable that you consult your healthcare providers and get their feedback. Their experience is invaluable.
Dick Brown
Palm Desert
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