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Do I Have A Chance Against My Health Insurance Company If I Get A Lawyer Involved?

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Do I Have A Chance Against My Health Insurance Company If I Get A Lawyer Involved?

Postby Avenill » Thu Aug 17, 2017 12:26 pm

My health insurance plan does not cover a residential program that my doctors and I believe may be my last chance at defeating a life-threatening illness that I have. I have exhausted all less-intensive treatment options that are covered and they have failed. I have almost died and been hospitalized (which is covered) short-term five times for this problem, four times this year, and three times this month and this treatment has failed. Even though the residential program is not in the plan, is it legal for them not to cover it when my doctors and I agree that it may save my life? Is it legal for them to potentially let me die because of syntax? I'm considering getting a lawyer. I was wondering if it's worth bothering. I live in Wisconsin.
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Do I Have A Chance Against My Health Insurance Company If I Get A Lawyer Involved?

Postby Chayne » Fri Aug 18, 2017 12:57 am

It's illegal for them to cover something they contractually don't cover.
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Do I Have A Chance Against My Health Insurance Company If I Get A Lawyer Involved?

Postby mylo70 » Fri Aug 18, 2017 5:46 am

You have a chance of living if you pay for the program, yourself, with your own money, without using insurance.

It is not legal for them to physically prevent you from getting into this program, by chaining you to your bed, for example.

It is usually legal for them to refuse to cover it.

But your last chance is not trying to get them to pay.

Your last chance is paying with your own money, without using insurance.

By refusing to pay for it, they are not "letting" you die, any more than you are letting yourself die, by refusing to pay for it yourself.
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Do I Have A Chance Against My Health Insurance Company If I Get A Lawyer Involved?

Postby Maddocson » Sat Aug 19, 2017 1:39 am

So.
You bought a plan that doesn't cover something, and you're complaining that it doesn't cover what you didn't buy.

Do you complain at the McDonald's drive-through when they don't give you a lobster, when you bought a burger?

Your lawyer isn't going to help.
They're not "letting" you die.
If you want that rehab program badly enough, go pay for it.
If you only want it, if someone ELSE is paying for it, you don't want it that badly, do you.


Additionally - I'll just put it out there.
Whatever the issue is - residential programs NEVER have much of a chance of success.
There are usually other MORE EFFECTIVE, less expensive ways to treat, REGARDLESS of what the issue is.


Odds are, that program you want, takes NO insurance - cash patients only.

How do you KNOW it's a waste of time to get a lawyer? Go try to get a lawyer.
No one will take this case on a no win no fee basis - which tells you, you don't have a case.
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Do I Have A Chance Against My Health Insurance Company If I Get A Lawyer Involved?

Postby Delmon » Sat Aug 19, 2017 11:03 am

If your policy is written to not include residential treatment, you have little recourse. I work for a substance abuse treatment center, and we have had many clients without residential coverage go up against their insurance companies.

Unfortunately, if residential coverage is not included in your benefit package, they have no legal obligation to provide it, regardless of the severity of your condition. I do not agree with that stance, but I have never seen anyone get coverage, when the policy states that it is not a covered benefit.

There are treatment centers that will still accept you, if you have coverage for detox, for IOP, or for partial hospitalization. There are also centers that offer financing, if you have a family member that might be willing to cosign for you. Please don't get discouraged, there are options. [email protected]
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Do I Have A Chance Against My Health Insurance Company If I Get A Lawyer Involved?

Postby Rumford » Mon Aug 28, 2017 7:40 am

Yes, it is perfectly legal for them to exclude the program from coverage.
Especially if the treatment is considered experimental, but even if not, yes, the insurance company is allowed to set limits to coverage, where you can get covered coverage, etc.
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