Reporter: This is Joel Block for The Law and You with Eugene attorney Don Corson. Don, one person asks what happens if a health insurance company denies coverage for a necessary procedure.
Don: Well Joel, first of all remember that HMO’s and other insurance companies are not in business to give away money. Sometimes decisions on what will be covered are made by people who don’t have adequate medical training. One of our clients came to us after her health insurance refused to pay for a surgery that her treating doctor said was needed to treat a life threatening condition. We discovered a memo in which the insurer complained about the cost of surgery and suggested that only a limited number of the procedures would be approved regardless of medical necessity. That led to our client’s surgery being paid for and fair compensation given for additional medical bills and the decline in her health caused by the delay in treatment.
Thank you, Don. If you have a legal question, or for a copy of How the Law Works, visit the Law Firm of Corson & Johnson at CorsonJohnsonLaw.com. The Law and You is a community service and does not replace the advice of an attorney.