My insurance company denied my surgery 1 day befor I was going under the knife. I had seen heart doc and others in preperation for the surgery. I was even preadmitted at hospital and had arranged my FMLA for work. Surgeon called and said insurance co. deemed as cosmetic which he and I know was poppy cock but it still happened and I am know under new insurance and am seeing a surgeon soon. So make sure your insurance co. is educated about HS and knows that the surgery is necessary not cosmetic.

I have no idea, but it really shouldn't be! And David, that's awful, I'm so sorry you had to cancel your surgery and I hope your surgery gets covered soon so that you find relief.

I'm sure it would depend on the company but I'm surprised that any insurance company would consider it cosmetic - David, that is awful!

No, when I got surgery a couple of years ago we put the claim request in as "re-constructive surgery." Which is exactly what it is. It a deformational disease which requires reconstruction to get the body beck into your normal state. As for David, I'm sorry that it happened. Insurance companies will put up a fight to deny any/all claims. Fight for your rights and your health.

Therefore, no it is in no way shape or form cosmetic surgery.

what about medicaid? everything i have read points to surgery for HS as being called cosmetic, which is not covered by medicaid.

found it

Plastic Surgery (reconstructive, including hidradenitis suppurativia): CUMC Dept of Plastic Surgery Consultation x5-5868

http://www.medicineclinic.org/referrals.html#pqr

3.1 General Criteria
Medicaid covers reconstructive surgery when it is medically necessary and
a. the procedure is individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the recipients needs;
b. the procedure can be safely furnished, and no equally effective and more conservative or less costly treatment is available statewide; and
c. the procedure is furnished in a manner not primarily intended for the convenience of the recipient, the recipients caretaker, or the provider.

http://www.ncdhhs.gov/dma/mp/1-O-1.pdf


When the Procedure Is Not Covered
IMPORTANT NOTE: EPSDT allows a recipient less than 21 years of age to receive services in excess of the limitations or restrictions below and without meeting the specific criteria in this section when such services are medically necessary health care services to correct or ameliorate a defect, physical or mental illness, or a condition [health problem]; that is, documentation shows how the service, product, or procedure will correct or improve or maintain the recipients health in the best condition possible, compensate for a health problem, prevent it from worsening, or prevent the development of additional health problems.

so does this mean anyone over 21 are not covered?

No, people over 21 are covered.

That simply means that if for any reason someone under 21 is denied treatment that he or she may be able to still get treated due to their age.

I'm glad you found this!! Good luck :)

my state does not cover the surgery

Washington State Medicaid

Plastic Surgery Community Health Plan Cosmetic surgery is NOT COVERED.

http://hrsa.dshs.wa.gov/gaumc/BenefitsChart.shtml

i have contacted my local medicaid office to see what my options are.

im really tired of having to educate on HS all the time, i just want to crawl into a hole and die

I think cosmetic tends to lean towards an issue of vantiy....like breast implants or rhinoplasty; reconscructive I think is what HS surgery is....cutting out and reconscructing skin for grafts?

I may be wrong do not have a definitive answer....but Nip Tuck is one of my favorite shows lol

Ooooh well if you have it on the good authority of Nip Tuck. You MUST be an expert. LOL Dustin.

You def have a case to combat them if they want to deny it. This is not for vanity this is for sanity and survival. If they decline it you can mention you are hiring an attorney and see how quickly they change thier minds.