This sounds like a violation of my civil rights to me... am I wrong? My health plan does not cover treatment of cystic acne, which is a type of acne characterized by very painful, deep pus-filled cysts, for anyone over 20 years of age. They say that for people over the age of 20, treatment of this diagnosis is considered "cosmetic" and therefore, not covered. Yet, treatment of the the same diagnosis for someone under 20 is not cosmetic? This seems like age-discrimination to me and a violation of my civil rights.
The insurer has responded that more than 75% of the health plans do not allow benefits for the treatment of acne for people over the age of 20. Is this shockingly unconstitutional to anyone besides me? The reason I have cystic acne is because I have a diagnosis of polycystic ovaries which throws off my hormone balance. I have painful cysts all over my ovaries, should I really have to suffer with paiful cysts on my face too? Cosmetic, my @$$. Suggestion/comments?
2007-04-06 03:52:59 · 4 answers · asked by CharmedTeri 2 in Politics & Government ➔ Law & Ethics
These links give more information on the different types of acne, incl. cystic:
http://www.acne.org/typesofacne.html
http://en.wikipedia.org/wiki/Acne_vulgaris
2007-04-06 03:54:02 · update #1
By the way, Lindsay, I know that it is NOT set in stone because I worked for an insurance company for 3 years. There are medical necessity reviews, which I am going through the process of right now.
2007-04-06 04:08:26 · update #2
Age is not a protected class except in some narrowly defined employment situations, so you have no civil rights.
I agree that medical necessity is your only basis for appeal.
2007-04-06 07:12:52 · answer #1 · answered by Scotty 4 · 0⤊ 0⤋
As you have said - fight for it on the basis of medical necessity and hope for the best.
The bottom line is that this is the companies policy, and it is not discriminatory because it states all people on the insurance policy are treated the same way. You carry the coverage therefore you agree to their terms.
You may not feel it is cosmetic, but many people think that dermabrasion and face lifts are not cosmetic either - the insurance company has to set limits and policies somewhere and that is where they have chosen to set it. Your "civil right" is that if you do not agree with a companies policy then you can rightfully choose not carry that insurance and select another company who better meets your health needs.
2007-04-06 11:45:17 · answer #2 · answered by Susie D 6 · 0⤊ 0⤋
No, sorry, you cant get around it. Acne is usually considered a condition during youth and once you hit about 20 or so it should go away. Too bad mine didnt either, so I know your frustration. But there are lots of conditions that they put on everything and it is legal because you are paying them to provide a service, insurance, and when you sign on for the service they expect you to know what you are getting.
Your best bet now is to shop around for treatments. Make sure you get the best price for what will work for you. But once an insurance company dictates something like that its in stone and when you sign up you agree to their conditions. Sorry.
2007-04-06 10:59:49 · answer #3 · answered by Lindsay 3 · 0⤊ 0⤋
You can keep appealing their decision. Get your doctor to state the acne is a symptom of the polycystic ovaries and not just plain acne. While I agree their policy is wrong, it is in your policy which when you subscribed you agreed to abide by it. Just keep fighting for the coverage. Our insurance co. originally refused to pay for my husband to have his teeth cut out because it was cosmetic. We fought it by having his dentist and doctors submit proof it was for health reasons. We won the appeal and they paid.
2007-04-06 11:04:28 · answer #4 · answered by mnwomen 7 · 0⤊ 0⤋