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insurance coverage for facial wasting
Aug 29, 2003

What are the individual circumstances by which I might receive insurance reimbursement for plastic surgery needed to ameliorate facial wasting from HIV meds? I have been positive for over 16 years and on meds for 13. It has been showing more and more the last five years after I started taking the triple cocktail. I am still able to work, but since my job does involve my appearance to a fairly large degree (the entertainment industry), I am finding less and less employment opportunities. I am afraid that if I do not do something to ammeliorate the facial wasting I will soon be out of work entirely. Also, the cosmetic surgeon I have met with recommends having an anesthesiologist during the procedure although he says it is not medically necessary. Should I spend the extra money and be put under? With the anesthesiologist he charges 5800 for this. It is 4300 without.

Thank You.

Response from Ms. Franzoi

If you live in California and your health plan is an insured plan, California Health and Safety Code Section 1367.63 provides that after 7/1/99, plans must cover "reconstructive surgery." "Reconstructive surgery" is defined as surgery that is performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease and is to improve function or create a normal appearance. The Department of Managed Health Care (DHMC) has stated the this section of the Code arguably requires plans to cover lipodystrophy treatments. However, if you are in another state or are covered under a self-insured plan, these treatments might be excluded as cosmetic.

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