RECONSTRUCTIVE SURGERY: Figueroa Wants Mandatory Coverage
State Assembly Insurance Committee Chair Liz Figueroa (D-Fremont) will hold a hearing tomorrow on a bill (AB 1621) that would mandate insurance coverage for needed reconstructive surgery. Physicians and patients will testify about the increasing difficulty they are having in getting HMOs and other insurers to cover reconstructive surgery (release, 2/22). Figueroa's bill would require health plans and insurers to cover reconstructive surgery defined as "surgery performed on abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease" in order to improve function or "give a patient a normal appearance." Under the bill, the treating physician would determine if a particular surgery met the definition of a reconstructive procedure. The bill would also deem reconstructive surgery medically necessary under Medi-Cal (bill text, 2/19).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.