I had the surgery in February of this year. The purpose was rhinitis surgery + I had a non-prosthesis (nasal tip cartilage) surgery while my nose was open.
The reason I decided to get the rhinitis surgery is because my nose was so crooked that I lived my whole life with stress
about its appearance, and because of that crooked nose, I suffered from severe rhinitis + periodic sinusitis. After visiting several
ENT clinics , I found out that I had a deviated nasal septum and I went ahead with it with the hope that it would get better if the structural problem was improved.
(It was so crooked that all the doctors at the four hospitals I consulted with said, “Did you hit someone? It was so badly crooked.”)
Before the surgery, I asked the insurance company if the four surgical insurance codes that the hospital mentioned were necessary were covered, and I
received a yes for all of them, so I went ahead and got rhinitis + cosmetic surgery, including nasal valve reconstruction/deviated septum.
I even got a separate receipt because I got cosmetic surgery like nose tip reduction, cartilage tying, and crooked nose correction, and they said that they don't cover insurance claims.
(This means that I had no intention of receiving it for cosmetic purposes.)
Then, in March, I filed an insurance claim,
but among the rhinitis surgeries, nasal valve reconstruction was deemed ineligible for insurance payment
. The reason was that I sought medical advice, and the insurance company's advisory opinion was that surgery was not necessary.
(In case of medical advice, when I asked the hospital, they said that the surgery was necessary, and that the medical opinion and surgery log could all be disclosed, so
it was okay to agree to the advice. In the first place, the insurance company told me that if I didn't agree to the advice, payment would be delayed or
difficult, etc., and that I had to agree, so I agreed.)
In the first place, the doctor at the hospital diagnosed nasal valve stenosis and performed surgery because it was necessary, so that doesn't make sense.
When I asked again, they said that if I can't accept the appraisal results, I have to get an appraisal from the insurance company employee at the same time?
The insurance company already knew that they would go to the hospital that would benefit them, so
I couldn't accept the results, so I went to another university hospital myself and got a specialist's opinion
. The specialist's opinion was, "Nasal valve stenosis was found. It seems that surgical treatment is necessary, so surgery will be performed. This
is a treatment-oriented surgery due to incomplete nasal breathing caused by the stenotic nasal valve." They
asked me if that was true at the time. Anyway, when I contacted the insurance company to submit these documents, they said
they couldn't accept them. They told me that I had to get a simultaneous evaluation, so why did I go alone? They said that
this was against their standards, so they couldn't accept it, and that I had to go with them and get a simultaneous evaluation.
They said that it would be difficult to proceed otherwise, so I submitted my application to get a simultaneous evaluation, but
when I looked it up, they said that a simultaneous evaluation is really a last resort, so if it comes out as unsuitable, it'll be difficult to change my mind or raise an objection?
I honestly don't even know what a valve reconstruction is. The doctor in charge said I needed it, so I went ahead with the surgery, and
since it would be covered by insurance, I thought it would go smoothly... Even
though it was a bit creaky, I went to a university hospital and even got an opinion that it was a necessary surgery. Now, they won't even accept it... In the end, when I get a simultaneous evaluation,
they're just going to go to a hospital that's advantageous to them... It makes no sense, I feel wronged, and angry, but since this is my first time, I don't know what to do.
Has anyone had a similar experience to me? If there's a case where they eventually got it, if
there's a recommended method, please leave a comment. ㅠㅠ
님
hzzzzj
