Can an insurance company deny to cover a breast MRI in the case of possible silicone implant rupture?
Get Legal Help Today
Compare Quotes From Top Companies and Save
Secured with SHA-256 Encryption
Can an insurance company deny to cover a breast MRI in the case of possible silicone implant rupture?
I am electing to have breast implants and am considering having silicone. This is my one concern. Although rare if suspected an MRI is the only way to tell and this can get pricey.
Asked on October 16, 2010 under Insurance Law, Florida
Answers:
M.T.G., Member, New York Bar / FreeAdvice Contributing Attorney
Answered 14 years ago | Contributor
Insurance companies make a determination as to approving or not approving procedures requested by a doctor by using a term we have all come to hate: medical necessity.
“Medically Necessity” means health care services and supplies provided by a health care provider appropriate to the evaluation and treatment of disease, condition, illness or injury and consistent with the applicable standard of care, including the evaluation of experimental and/or investigational services, procedures, drugs or devices. But what you and your MD think may be medical necessity, the Medical Director of your insurance plan may not. It could be denied and it could be appealed if that were the case. How good you are at docu,eting the matter and fighting the powers that be will also detemine if it is approved. The fact that the treatment is part of an elective surgery you had should NOT be a factor in deciding if the treatment is necessary. Good luck.
IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.