Are the insurance companies being fraudulent by there own rules?

 

by Cayleigh Wills on Tuesday, August 16, 2011 at 4:18pm

Are they insurance companies being fraudulent? Are they breaking their own rules?
I read that they will cover "medically necessary" surgeries. So the question is what is "medically necessary"? "Care is considered medically necessary if:
1) It is accepted by the health care profession in the U.S. as approproate and effective for the condition being treated.
2) It is based upon recogonized standards of the health care speciatlity involved.
3) It represents the most appropriate level of care: the frequesncy of serices, the duration of services, and the site of services, depending on the seriousness of the condition being treated ( such as hospital or in the physicians office), and
4) it is not experimental or investigational
*quoted from http://www.tgender.net*

So what is the problem? Why won't the insurance companies cover such important surgeries such as mastectomies, phaloplasty, vaginoplasty, etc?
They are accepted by the health care professionals in the U.S.
They are based on recognized standards of the health care speciality involved.
They represent the most appropriate level of care in most cases. And in those cased that it doesn't, it's because those individuals elected not to have them,
These surgeries are most definately not experiemental or investigational.
In my opinion, the insurance companies are fraudulent.