Insurance in Puerto Rico?

Question

I have an issue of someone I know who can't get any medical help. They have insurance in Puerto Rico from an insurance place known as, "SSS." She was going to get surgery and that was the plan. But now the medical/hospital is saying that they cannot perform the surgery because the condition isn't, "bad enough." So they can't do it at all anymore. So what do we have to do, just wait until the condition gets WORSE? Because that is insane! She has INSURANCE, which is to cover the pay of the surgical needs, but the doctors are saying nothing. What is going on here? I'm desperately in need of some answers.. Thanks.

Answer 1

She can have it done and self pay, if she wants to, or she can wait until the condition gets worse.  Or, she can try to appeal the decision.  

If the doctors are recommending she doesn't have the surgery, I don't understand why you - and she - won't trust the doctors.  

Generally, though, insurance companies won't pay for experimental procedures, or voluntary procedures, including gastric bypass, lap band, infertility treatment, cosmetic surgery, s*x change operations, etc.

I don't know what's going on here.  Likely, YOU don't have the whole story, either.