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
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