Insurance issues

Sadly, many insurance carriers deny coverage, as vascular anomalies fall into category of congenital malformations. The other reason to reject the coverage is that they consider the correction to be a case of cosmetic surgery. Contracts usually do not cover pre-existing conditions. (Conditions existed before the day that the contract with the insurance company was signed.) However, some patients have successfully convinced insurers and managed to be covered. Our administrative staff can advise you, but there are some steps that you may take to help establish your case.

1. Gain the support of a doctor, within your insurance network. Because you will likely have to consult with a specialist who does not participate in your health coverage plan, you will need to gain the support of a physician within your plan network. Provide him or her with as much information as you can about your child's condition. Vascular birthmark treatment is a relatively new and fast growing field, so your physician may not be aware of all the facts and new treatments options. Having your insurance agent on your side will also be helpful.

2. Keep a diary of your child's condition - Document when you first noticed the lesion, any changes you detect, incidence of bleeding, whether it interferes with the child's eating, speaking or other activities, physician visits, etc. Include dates and descriptions.

3. If denied your claim, obtain a written explanation - Call the Medical Case Management Department of your health insurance company to learn exactly what steps you must take to appeal the denial. Most carriers have several levels of appeal. Hiring an attorney is not usual necessary. Most companies allow you to submit a letter containing precise information about your child's condition. Your diary will be invaluable in preparing this.

4. Try to contact your insurance company claims adjuster. Send this person photos and articles about your child's condition.

5. If your appeals fail, send a letter to the company. Use key phrases like "quality of life," describe bleeding incidents or the potential for interference with your child's normal activities, such as eating or speaking. Remind the company's administrators that treatment by a specialist will ultimately result in fewer doctor visits and costly complications, ultimately saving money. Some parents have been successful in overturning their insurance carrier's denial this way.

/