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Medical Insurance and Snoring

Currently, many major medical insurance policies state that the costs of experimental, cosmetic, or investigative procedures are not covered. Yet, your health plan may actually cover these types of procedures. You just have to follow a few steps and prove that there is, indeed, medical data and justification to warrant coverage for these services.

Most health insurance companies choose not to cover cosmetic or investigative procedures, such as rhinoplasty, because they are typically uncommon medical practices or new, experimental treatments that do not yet have validated results. These procedures are generally referred to as "elective" procedures, deemed so by doctors and insurance providers because they are rarely medically necessary. To be considered medically necessary, the services must be generally accepted by the medical community, have proven results, and be relatively less expensive than alternative treatments. Health insurance providers are reluctant to supply coverage for expensive, unrecognized, or new medical treatments.

While many cosmetic procedures are labeled as vanity surgeries, a large number of investigative, elective procedures have nothing at all to do with vanity, such as angioplasty or hip replacement. The angioplasty procedure uses a balloon to open a blocked coronary artery and improve blood flow to the heart. It is considered an elective procedure because, although it will likely prevent a future heart attack, angioplasty is not a life-saving procedure. Similarly, a hip replacement may improve quality of life, but it is not a procedure performed to save a person's life.

Sometimes physicians do find cases in which elective procedures are medically necessary. To get these types of procedures covered, HealthSymphony, a comprehensive health insurance Web site, offers some suggestions on steps you can take get the services you want. You must provide the insurance company with sufficient medical data about the procedure to justify its coverage. This requires research. You need to find at least two articles from respected medical journals that provide the results of studies performed regarding the procedure. You also need to obtain a statement of medical necessity from the physician who is requesting the treatment. If your doctor truly believes that the procedure is necessary to improve your health and quality of life, the chance of receiving coverage from your health insurance provider greatly increases. All of the information you gather will be presented for consideration in front of the medical board and medical director of the health plan.

The information you provide initially may not be enough, and coverage for these experimental and cosmetic procedures may still be denied. In this case, you should contact your insurance company directly and state your case. Do this by writing an appeal letter, and include statements regarding the necessity of the procedure from your physician or surgeon. You will also want to provide all relevant test results and x-rays to help prove your case.

Because of unfamiliarity and lack of validated test results, many medical procedures are labeled "elective procedures," and are therefore unqualified for coverage by most health insurance policies. But, if you provide sufficient evidence and appropriate test results, your health insurance provider may consider supplying coverage.


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