RE: Re: paying for surgery

[Guest guest]

Our daughter has not had surgery yet and it's a mild case, I think...but

I asked our doctor if insurance usually covers the surgery and he said

he would make sure that it did. We'll see...Can your doctor explain to

the insurance company why surgery is necessary? Maybe he's already done

that. Even if eyesight is not impaired, (as in our case), the eye

lashes sometimes turn in and scratch the eye--I'd consider that a

medical reason for surgery, not cosmetic! Let us know what you find out

as you pursue this. Best wishes, Sheila Mathias

Durant, Iowa

blepharophimosis Re: paying for surgery

I am not an expert in insurance or any of this issues but

first I would look at the reason they are denying your claim, do they

think it is cosmetic? Because it isn't, your child is around the same

age as Lily and if his vision is inhibited the surgery is necessary for

his development.

Have you spoken to your employer?

Other options would be public assistance, changing insurance companies,

changing jobs. Can another family member put your son on their

insurance?

I am so sorry you have to deal with this on top of having a little baby

who needs surgery.

>

> Hi my son and I have Bleph and my ins. will not cver it what should i

> do.

[Guest guest]

In my experience, most insurance companies that want to try to avoid

paying for this surgery will usually insist that this is a cosmetic

procedure.

The way my family dealt with this was to have our doctor raise the high

risk of deformity that would result if the surgery was not performed.

In my case, this would mean I would have had to tilt my head back to see

for the rest of my life, which would have most likely resulted in neck

injury/long term disability on my part.

The other argument I have heard made to insurance companies is that

sight will be impaired, if the pupil is partially covered by the eyelid.

Again, there are potential long term consequences to this, and insurance

companies have a difficult time making the argument that the issue is

simply cosmetic.

The one area that insurance companies have been able to find wiggle room

is if they have a 'preexisting condition' clause which bars your child

from receiving care for any problem that he/she was born with. While

most policies in the U.S. do not (cannot?) do this, I have heard of this

in a couple of cases.

Hope this helps,

Micah

blepharophimosis Re: paying for surgery

I am not an expert in insurance or any of this issues but

first I would look at the reason they are denying your claim, do they

think it is cosmetic? Because it isn't, your child is around the same

age as Lily and if his vision is inhibited the surgery is necessary for

his development.

Have you spoken to your employer?

Other options would be public assistance, changing insurance companies,

changing jobs. Can another family member put your son on their

insurance?

I am so sorry you have to deal with this on top of having a little baby

who needs surgery.

>

> Hi my son and I have Bleph and my ins. will not cver it what should i

> do.

[Guest guest]

hi there, although we live in Canada and most of any and all kinds of medical anything is always covered... I remember talking with my sons surgeon and he did mention that sometimes he has to put in a special request for this type of surgery with Alberta health care (our province healthcare) because they do consider it cosmetic, but............. for most it is necessary because of vision, he told me if the lids obstruct the vision in anyway at all it will make your eyesight worse day by day so in that case it turns out it has to be medically necessary... is your son's eyesight obstructed??

Tonikka and Chris

-----Original Message-----From: blepharophimosis [mailto:blepharophimosis ]On Behalf Of Micah TrumanSent: April 14, 2005 7:36 PMblepharophimosis Subject: RE: blepharophimosis Re: paying for surgeryIn my experience, most insurance companies that want to try to avoidpaying for this surgery will usually insist that this is a cosmeticprocedure.The way my family dealt with this was to have our doctor raise the highrisk of deformity that would result if the surgery was not performed.In my case, this would mean I would have had to tilt my head back to seefor the rest of my life, which would have most likely resulted in neckinjury/long term disability on my part.The other argument I have heard made to insurance companies is thatsight will be impaired, if the pupil is partially covered by the eyelid.Again, there are potential long term consequences to this, and insurancecompanies have a difficult time making the argument that the issue issimply cosmetic.The one area that insurance companies have been able to find wiggle roomis if they have a 'preexisting condition' clause which bars your childfrom receiving care for any problem that he/she was born with. Whilemost policies in the U.S. do not (cannot?) do this, I have heard of thisin a couple of cases.Hope this helps,Micah-----Original Message-----From: blepharophimosis [mailto:blepharophimosis ] On Behalf Of mathiasSent: Friday, April 15, 2005 5:35 AMblepharophimosis Subject: RE: blepharophimosis Re: paying for surgeryOur daughter has not had surgery yet and it's a mild case, I think...butI asked our doctor if insurance usually covers the surgery and he saidhe would make sure that it did. We'll see...Can your doctor explain tothe insurance company why surgery is necessary? Maybe he's already donethat. Even if eyesight is not impaired, (as in our case), the eyelashes sometimes turn in and scratch the eye--I'd consider that amedical reason for surgery, not cosmetic! Let us know what you find outas you pursue this. Best wishes, Sheila MathiasDurant, Iowa-----Original Message-----From: bethgordon03 [mailto:bethgordon03@...] Sent: Thursday, April 14, 2005 9:44 AMblepharophimosis Subject: blepharophimosis Re: paying for surgery I am not an expert in insurance or any of this issues butfirst I would look at the reason they are denying your claim, do they think it is cosmetic? Because it isn't, your child is around the same age as Lily and if his vision is inhibited the surgery is necessary for his development.Have you spoken to your employer? Other options would be public assistance, changing insurance companies, changing jobs. Can another family member put your son on their insurance? I am so sorry you have to deal with this on top of having a little baby who needs surgery. > > Hi my son and I have Bleph and my ins. will not cver it what should i > do.

[Guest guest]

Hello, living in The Netherlands I think we have a different health insurance structure so I cannot comment on the question itself but isn't there any jurisprudence with similar cases in Iowa or the USA that you might use to "convince" your insurance cy?

In The Netherlands, Germany and Austria surgery for BPES is NOT considered te be a cosmetic surgery.

Good luck and best regards,

Dolph Heideman (from Purmerend - The Netherlands)where the tulip fields in blossom are colouring the area.)

RE: blepharophimosis Re: paying for surgery

In my experience, most insurance companies that want to try to avoidpaying for this surgery will usually insist that this is a cosmeticprocedure.The way my family dealt with this was to have our doctor raise the highrisk of deformity that would result if the surgery was not performed.In my case, this would mean I would have had to tilt my head back to seefor the rest of my life, which would have most likely resulted in neckinjury/long term disability on my part.The other argument I have heard made to insurance companies is thatsight will be impaired, if the pupil is partially covered by the eyelid.Again, there are potential long term consequences to this, and insurancecompanies have a difficult time making the argument that the issue issimply cosmetic.The one area that insurance companies have been able to find wiggle roomis if they have a 'preexisting condition' clause which bars your childfrom receiving care for any problem that he/she was born with. Whilemost policies in the U.S. do not (cannot?) do this, I have heard of thisin a couple of cases.Hope this helps,Micah-----Original Message-----From: blepharophimosis [mailto:blepharophimosis ] On Behalf Of mathiasSent: Friday, April 15, 2005 5:35 AMblepharophimosis Subject: RE: blepharophimosis Re: paying for surgeryOur daughter has not had surgery yet and it's a mild case, I think...butI asked our doctor if insurance usually covers the surgery and he saidhe would make sure that it did. We'll see...Can your doctor explain tothe insurance company why surgery is necessary? Maybe he's already donethat. Even if eyesight is not impaired, (as in our case), the eyelashes sometimes turn in and scratch the eye--I'd consider that amedical reason for surgery, not cosmetic! Let us know what you find outas you pursue this. Best wishes, Sheila MathiasDurant, Iowa-----Original Message-----From: bethgordon03 [mailto:bethgordon03@...] Sent: Thursday, April 14, 2005 9:44 AMblepharophimosis Subject: blepharophimosis Re: paying for surgery I am not an expert in insurance or any of this issues butfirst I would look at the reason they are denying your claim, do they think it is cosmetic? Because it isn't, your child is around the same age as Lily and if his vision is inhibited the surgery is necessary for his development.Have you spoken to your employer? Other options would be public assistance, changing insurance companies, changing jobs. Can another family member put your son on their insurance? I am so sorry you have to deal with this on top of having a little baby who needs surgery. > > Hi my son and I have Bleph and my ins. will not cver it what should i > do.

[Guest guest]

I am not sure about where you live but here in California we have CCS

(California Children's Services) Any child born with a congenital condition gets

free services- surgeries, medications, dr.'s appointments... all of it. It's

government paid for. I'm not sure if there is a salary requirement or not but I

qualified for it. Look into it and see if you are offered anything where you

live.

's mom

From: mathias [mailto: mathias@...]

blepharophimosis

Date: Thu, 14 Apr 2005 16:34:54 -0500

Subject: RE: blepharophimosis Re: paying for surgery

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Our daughter has not had surgery yet and it's a mild case, I think...but<BR>

I asked our doctor if insurance usually covers the surgery and he said<BR>

he would make sure that it did.  We'll see...Can your doctor explain to<BR>

the insurance company why surgery is necessary? Maybe he's already done<BR>

that.  Even if eyesight is not impaired, (as in our case), the eye<BR>

lashes sometimes turn in and scratch the eye--I'd consider that a<BR>

medical reason for surgery, not cosmetic!  Let us know what you find out<BR>

as you pursue this.  Best wishes, Sheila Mathias<BR>

Durant, Iowa<BR>

<BR>

blepharophimosis Re: paying for surgery<BR>

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<BR>

I am not an expert in insurance or any of this issues but<BR>

first I would look at the reason they are denying your claim, do they <BR>

think it is cosmetic? Because it isn't, your child is around the same <BR>

age as Lily and if his vision is inhibited the surgery is necessary for <BR>

his development.<BR>

<BR>

Have you spoken to your employer? <BR>

<BR>

Other options would be public assistance, changing insurance companies, <BR>

changing jobs. Can another family member put your son on their <BR>

insurance? <BR>

<BR>

I am so sorry you have to deal with this on top of having a little baby <BR>

who needs surgery. <BR>

<BR>

<BR>

<BR>

> <BR>

> Hi my son and I have Bleph and my ins. will not cver it what should i <BR>

> do.<BR>

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