Nov 29, 2004
Last Sept I had bio-alcamid injected to repair my face from lipoatrophy. UNfortunately, too much product was used and I have what looks like a black eye. The clinic where I had it done has a great reputation, Tijuana, Mexico, but they want me to pay for the plastic surgeon to fix this. I want to fix it bec. it causes me pain when I touch it and when the weather changes. Would my indemnity plan pay for this fix? The policy has a ded. of $2500 per illness and so far the only ded,. I have met is for hiv.So, could you see a claim for lipoatrophy repair being paid. ONe more issue, I reside in Calif. where the compa=pnies have to pay for restoration I'm told, but my premiums are billed to my NJ home because I live there most of the time. I want to takecare of this in San Diego, What do youthink about getting this proedure paid by my indemnity plan.Equitable.Thank you,.Luke
| Response from Ms. Franzoi
Without more information it is difficult to answer this question. Are you under a group policy or an individual policy? The NJ and CA residences vs. billing addresses add some complexity. Whether or not your plan will pay for a plastic surgeon to fix this depends on the terms of the plan. Many indemnity plans won't pay for any medical costs incurred as the result complications from a procedure that wasn't covered. Although California law can be interpreted to require coverage for lipodystrophy, it has to be an insured plan and the diagnosis must fall within the guidelines of the plan. I suggest that you contact the administrator and ask whether or not such a procedure would be covered.
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