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Dayton, Ohio

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Chrissie Cole
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Insurance Company Refuses to Pay For Breast Birth Defect Surgery

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A mother’s insurance claim has been denied twice by her insurance provider. After paying for her health insurance every month, she didn’t expect an insurance claim denial.

Her 14-year-old daughter has what her doctors refer to as a birth defect. But, the insurance company says the procedure is cosmetic and not medically necessary, so they are refusing to cover it.

The doctor diagnosed her daughter with Poland’s Syndrome, which is an absence or underdevelopment of the chest muscle on one side of the body. The Mother says her daughter has a C-cup on the right side and the left side is barely an A.

The insurance provider says services for, or related to, cosmetic surgeries are not covered by her plan. And the teen’s condition does not, in their opinion, fit the definition of Poland’s Syndrome. She argues her daughter’s condition goes much farther than skin deep.