Need Advice on health insurance coverage!!
Posted in the Health Insurance Forum
I suffer from severe chronic sinusitis which is really affecting my life. My ENT highly recommends balloon sinus ostial dilation (balloon sinuplasty) as an effective and safe procedure with minimal risk to fix my specific issue that is causing the sinusitis. The other alternative is endoscopic sinus surgery but given my adverse reaction and recovery from previous procedures (deviated septum, tonsillectomy and adenoidectomy), my doctor and I feel that the risk is too high for endoscopic sinus surgery. My insurance provider has denied pre-authorization because it claims the procedure is never medically necessary and always investigational. They say they are not convinced it is as effective as endoscopic surgery and will not grant an exception where that surgery is not a viable option. The procedure is covered by practically every other insurance provider including medicare and Medicaid. I have requested an independent review.
Any advice would be much appreciated. In the event the procedure remains denied, is there any form of supplemental insurance that would cover this.
Thanks in advance.
Since: Jan 14
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