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Necessity overrides specific exclusion


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Posted by Sheldon Weinhaus on March 22, 2001 at 19:40:42:

In a case decided by the United States Court of Appeals for the Eighth Circuit today,
Milone v. Exclusive Healthcare, the health policy exclused all costs of breast augmentation and/or reduction, except for cancer. Nonethelless , once or twice the insuer made an exception for reduction, when there was no cancer. the court held where the reduction was admittedly medically necessary, it must be covered notwithstanding the specific exclusion. therefore, always ask about consistency if they spring an exclusion on a policyholder.

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