I am looking for help to make a case with my insurance provider to overturn a laser treatment denial for a pws on my 3 year old's face between his temple and eye. Although it is a small pws (about the size of a quarter), we would still like to begin laser treatments. The specialist we went to said that it would cost $3,000+ per treatment if not covered by insurance. I am looking for help to convince the insurance company that it IS medically necessary. I have traditional BC/BS. Has anyone successfully appealed a pws that may not be "medically necessary"? By the way, we were also told by our doctor that it would eventually go away.
Hi Leah. Corinne gave you a good link. You can also try http://www.birthmarks.com
They have a section about appeals, and even letters about the medical necessity of treating a PWS. I have heard from many people that they have to appeal before it is approved. Hang in there and fight them. It may not be a pretty road to take but in the long run, it is worth it.
Good luck and keep us posted.
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