Posted By: LilyFoo Cancer Plcy Correct Stoma Defect Not Covered - 03-01-2016 07:23 PM
My cancer policy is denying my claim for my husband's recent surgery to correct a Tracheostomy defect noted on his last PET scan. His stoma was so small that even a child's size lary tube could not be inserted. Under the surgery benefit the definition of a covered surgery reads "for the purpose of treating a diagnosed cancer." It also has a Prosthesis coverage. Could I claim his stoma as a prosthetic device since it replaces a normal body function?

I think since his stoma was created due to cancer treatment that the correction of the defect is still cancer treatment. It's not from anything else!

Anybody had this fight with an insurance company?

Im sorry you are having to deal with insurance companies on top of everything else. All too often insurance companies will deny claims. The next step is to appeal their decision. If possible include a letter from the physician explaining everything in detail including how its still related to his cancer and its treatment.

From what I remember when I had to battle my insurance company was that with letters from my doctor and a phone call or 2 they eventually approved the claim. I learned to not give in and accept their decision. Even if they make it difficult, keep appealing until you have exhausted all avenues. I had 2 denials until I could get the insurance company to cover my procedure.

Good luck!!!
Thank you! I have requested a letter from his surgeon. Sheryl
Instead of writing a letter Charles' surgeon called the insurance company. This morning the insurance company approved the claim! Thank you for encouraging me not to give in.
© Oral Cancer Support - Survivor / Patient Forum