Negotiating with Insurance Companies for Plastic Surgery Coverage for Burn Injuries

A severe burn injury significantly affects a victim’s quality of life. From the immediate aftermath to their future, victims suffer physically, emotionally, and financially.

Burn victims know best the actual impact such an injury can have on their careers, relationships, and daily existence.  Plastic surgery targets reconstruction and function, which are elements critical to improving a burn victim’s quality of life. A burn injury is traumatic enough. Discovering your insurance company seeks to deny coverage or underpay for plastic surgery is an additional and unfair stress. No burn victim should pay out of pocket for exorbitant medical expenses associated with plastic surgery.

A compelling narrative and proof of the effects of a burn injury and how plastic surgery can improve patient function are crucial to negotiations. Victims can manage negotiations but must never settle for less than they deserve regarding coverage or compensation.

This blog covers tips on the why and how of insurance company policies and negotiations. These tips can guide you on best practices and knowing when to contact an Atlanta burn injury attorney.

Why Insurance Companies May Deny or Minimize Coverage

Plastic vs. cosmetic misclassification is a common issue.

Plastic surgery and cosmetic surgery are often intertwined terms. When an insurance company views the two procedures as similar, it generally declines coverage.

The reality is that plastic surgery and cosmetic surgery are different procedures, each with its own specific outcome goals. It is essential for victims and insurance companies to understand the meaning of each type of surgery:

  • Plastic surgery: Surgery intended to repair missing or damaged skin or tissue function. It is also referred to as reconstructive surgery and is a standard part of burn injury care and recovery.
  • Cosmetic surgery: Surgery intended to improve a patient’s appearance. Cosmetic surgery is almost always elective, not health-related, and therefore is typically denied insurance coverage.

Confusion about the type of surgery is one reason insurance companies deny or minimize coverage. Other reasons commonly found in denial or minimization for insurance companies are:

  • Pre-existing conditions: Prior skin conditions may be one excuse an insurance company uses to refuse plastic surgery coverage.
  • Policy exclusions and limitations: While insurance policies are legally binding contracts, fine wording can impact coverage.
  • Cost containment: Insurance companies seek to protect profits by looking out for the company’s best interests—not the policyholder’s or, in negligence cases, the victim’s.

Learning why your claim was denied or minimalized is vital in the negotiation process. If your insurance company is unresponsive, unhelpful, and denying or minimizing your burn injury claim, you may want to contact an attorney as soon as possible.

Strategies for Effective Negotiation

Organization and communication are crucial.

Many policyholders take the terms of an insurance policy for granted until they file a claim. As businesses, insurance companies are reluctant to part with profits. Documentation and communication are among the crucial elements of effective insurance negotiation. Evidence supporting your claim and the necessity of plastic surgery helps make your case for coverage.

The details of how your accident occurred can determine the approach of your negotiations. For example, a burn injury without negligence places reliance on your insurance policy for coverage. An accident involving negligence may make the responsible person – and their insurer – accountable for your plastic surgery costs.

Burn victims in need of plastic surgery but facing pushback from insurance companies should gather the following:

  • Detailed medical records: medical costs relating to hospitalizations and surgeries
  • Letters of medical necessity from physicians: professional letters outlining why plastic surgery is necessary
  • Documented expenses relating to daily or monthly therapies and prescription medications
  • Estimation of future medical needs and related costs: ongoing or long-term costs such as rehabilitation following plastic surgery.

If you find the negotiation process too taxing on your emotional health, an Atlanta burn injury lawyer can help. By entrusting your legal issue to them, you can rest easier knowing someone is protecting your best interests.

When to Involve an Atlanta Burn Injury Lawyer

Sooner is better for protecting your rights.

An Atlanta burn injury lawyer understands how insurance companies operate and knows Georgia civil laws. A free consultation helps you and a lawyer understand if and how they can help you secure coverage or compensation for your medical needs.

An attorney gets to work for you by:

  • Ensuring proper documentation
  • Dealing with denials, delays, and disputes
  • Communicating case updates with you
  • Advising you on your legal options (i.e., a lawsuit).

Insurance companies have an advantage over burn victims unfamiliar with the negotiation process. The unevenness of this advantage places victims at risk of not securing the plastic surgery they so desperately need.

The expense of plastic surgery is a medical cost necessary for improving your ability to function. If you find the insurance approval process difficult and frustrating, consider contacting an Atlanta burn injury lawyer immediately.

The Stoddard Firm: Helping Atlanta Burn Victims

Let us manage the insurance company negotiation process.

A traumatic event resulting in severe burns turns your world upside down. The chaos and disruption to your daily routines and the pain of your injury leave little time for insurance negotiations. At The Stoddard Firm, we understand how confusing and complex the insurance and legal process is for burn victims.  We take pride in fighting for victims and the coverage they need and deserve.

The Stoddard Firm advocates for the rights of Atlanta burn victims by firmly negotiation for coverage or a fair settlement. Our free consultation allows potential clients to learn more about us and their legal options.

Time can pass in a blur following your accident. If a civil lawsuit is an option for your case, it must reach the court before the statute of limitations expires. The Georga statute of limitations is generally two years.  The sooner you contact us, the faster we can get to work for you. Do not let an insurance company deny or minimize your need for plastic surgery. Instead, get help from The Stoddard Firm today.

Call our friendly office today to schedule your free consultation: (470) 467-2200.

Attorney Matt Stoddard

Atlanta Personal Injury LawyerMatt Stoddard is a professional, hardworking, ethical advocate. He routinely faces some of the nation’s largest companies and some of the world’s largest insurers – opponents who have virtually unlimited resources. In these circumstances, Mr. Stoddard is comfortable. Mr. Stoddard provides his strongest efforts to his clients, and he devotes the firm’s significant financial resources to presenting the strongest case possible on their behalf. Matt understands that his clients must put their trust in him. That trust creates an obligation for Matt to work tirelessly on their behalf, and Matt Stoddard does not take that obligation lightly. [ Attorney Bio ]

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