Filed June 21 in a New Jersey District Court, the lawsuit alleges UnitedHealthcare is in violation of the Employee Retirement Income Security Act by not uniformly covering the post-mastectomy surgery. The lawsuit claims ERISA plans must cover the surgery, as the act ensures coverage for a range of breast reconstruction procedures.
However,UnitedHealthcare’s policies make it “unreasonably difficult” for patients to be insured for receiving the flap breast reconstruction surgery, especially when performed by an assistant or co-surgeons, the claim alleges.
UnitedHealthcare’s blanket policy on breast reconstruction surgeries states that post-mastectomy procedures performed by more than one surgeon is more than “medically necessary,” raising issues with assistant and co-surgeons performing the flap breast reconstruction surgery, according to the lawsuit.
At the time of publication, UnitedHealthcare was unable to provide a comment on the lawsuit.
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