Assymetry a condition?

[SLuskin]

We have a claim for the wife of an attorney in one of our law firm clients, who have submitted a claim for breast implants. She submitted a doctor's letter explaining that he was treating her for assymetry. This looks cosmetic to me, but I wanted other opinions because I know that this action will be harshly questioned by the client. Thank you for your help.

[QDROphile]

You may wish to inquire if the condition is caused by a congenital defect, disease or accident, but I suspect that if it were that easy, you would already have the explanation.

[namealreadyinuse]

Cosmetic (hopefully). Why isn't it just AN implant?

[Guest Pensions in Paradise]

I'm really ugly. Does plastic surgery qualify??

[Peanut Butter Man]

If she provided a letter from the treating physician saying that it was medically necessary, I would approve it. The treating doctor's opinion on whether something was medically necessary is better than my layman's opinion.

[jeanine]

Assymetry, or symetrical appearance, is mentioned specifically in the Womens Health and Cancer Rights Act. Implants are not cosmetic just because more than one breast is involved. A plan is required to pay for both breast implants following a mastectomy (single or double) if a double implant is necessary to produce a symetrical appearance.