Can you sue a health insurance company for denying medical coverage?

My doctor has referred me to have the gastric by-pass surgery. I've spent the last 4 months and countless money (of my own) getting all the things the done the insurance company has asked for. This includes psych evaluation, sleep study, nutrition counseling, physicals and documentation to include I have tried at least 2 non-surgical weight loss programs for over a year with no long term success. Finally after submitting everything, they denied me for "no recent active participation in a non-surgical weight reduction program". My last weight loss attempt was a year ago. I am about to lose my job because I cannot literally stand up on my feet anymore. This is something I have to get, not something I just want. It would seem if both my primary physician and the specialist both agree this is medically necessary, then the insurance companies couldn't deny someone their health.

Asked By: CMS - 11/14/2006
Best Answer - Chosen by Asker
Covering the gastric bypass and similar procedures is relatively new for insurances who have always lumped this with being cosmetic... More
Answered By: NyteShayde - 11/14/2006
Additional Answers (4)
They can and they have done it to other people. The treatment you are talking about is not 100% safe. Some people develop complication from it. Maybe that is why they reserve it as the last resort. It shouldn't be hard to participate in a non-surgical weight reduction program. After that, they may pay for the surgery... More
Answered By: spot - 11/14/2006
Insurance companies are not required to cover this sort of procedure. You should familiarize yourself with your policy to see if they are lying to you but chances are that they are in the right... More
Answered By: Badstudent - 11/14/2006
You could sue, but it's easier to file a complaint with your state's insurance commissioner's office. It's free and they have access to contracted physicians who review the medical necessity of the procedure. In this case, it appears the specialist would also review the carrier's medical necessity guidelines to see... More
Answered By: Suzanne - 11/14/2006
You can sue anyone for anything, so the answer is yes. The cost of the lawyer might be A LOT, you'll have to pay that up front... More
Answered By: mbrcatz17 - 11/14/2006
Sponsored results
Over 483 Local Jobs Now Hiring In Your Area. $18-$87/Hr - Apply Today!
Click. Search. Apply. Free!
Earn $95/hr Bookkeeping Right From Home. Free Video Explains All!
Become A Mystery Shopper. Immediate Start, No Fee, No Contracts

Other Career Questions

What is your current job? Why did you choose this job? What do you enjoy about your job? What do you dislike about your job? What would be your perfect job? Would you rather have this j...
3 answers - Asked By: drop pants not bombs!.♥ - 3/2/2010
Where are the jobs? Is productivity and globalization creating a permanent “recession” of jobs? My main issue is I am doing a paper for school and have no idea where to begin. I was hoping suggestions...
4 answers - Asked By: bayebd24【ツ】 - 11/21/2007
Hi ok im 19 and about to start college to do an acess course into a university. Ive been browsing through all the courses and im tottaly stuck! I thought politics but im scared ill end up with some r...
1 answers - Asked By: roseparkerly - 1/26/2009

Content is not owned or controlled by Monster. Any content concerns should be addressed with Yahoo!
Yahoo! Does not evaluate or guarantee the accuracy of any Yahoo! Answers content. Yahoo! Disclaimer.

Popular Articles

Best-Paying Work-from-Home Jobs Article Rating
It’s easier than ever to work from home. Of course, not every job is a mobile job, and some companies aren’t interested in having their employees work from home.
2013 Marketing Jobs Outlook Article Rating
The US may be facing another year of anemic hiring overall, but that won't be the case in the high-orbit world of multichannel, digital media marketing.
For Employers: Post Jobs | Search Resumes | Advertise
About Monster | Work for Monster | Advertise with Us | AdChoices | Partner with Us | Investor Relations | Social Media
Terms of Use | Privacy Center | Accessibility Center | Help | Security | Contact Us | Sitemap | Mobile
©2014 Monster - All Rights Reserved U.S. Patents No. 5,832,497; 7,599,930 B1; 7,827,125 and 7,836,060 MWW - Looking for Monster Cable? - V: 2014.1.40.24-319