Neighborhood Health Defeats Appeal Over Cosmetic Nasal Surgery

Neighborhood Health Partnership Inc. reasonably declined to cover a patient’s nasal surgery after determining it was intended to address cosmetic concerns rather than medical ones, the Eleventh Circuit ruled Wednesday.

The patient said Neighborhood’s decision preauthorizing her planned surgery with one doctor meant that the surgery she ultimately underwent with a different doctor in 2019 should be covered. The US Court of Appeals for the Eleventh Circuit disagreed, writing in an unpublished opinion that the preauthorization applied to a different procedure than the one that was actually performed.

• Abigail Gomez received preauthorization for a “blended treatment” that included both medically ...