The Law and Your Health

What to Do If You Have Problems

What options do I have when my health plan refuses to cover the treatment I need?

Your health plan should provide you with the process you need to follow to appeal the health plan’s decision. In some health plans the only thing you will need to do is to get your doctor to write a letter stating why the treatment is necessary. It can be useful to get the opinion of another doctor, in writing and probably at your own expense, and submit that to the health plan.

In a few states the law gives you the right to complain to an independent reviewer that will make its decision and, if it decides in your favor, has the authority to make the health plan cover your treatment.

Regardless of the law in your state, you will need to go through the health plan’s appeal process before you can consider taking your health plan to court.

>>What options do I have when my health plan refuses to cover the treatment I need?
>>Can I recover damages from my health plan when it does not live up the promises in the health plan’s brochure?
>>Is the health plan legally responsible if I am injured because of a doctor’s mistake?
>>How can I recover from my health plan for negligence?
>>What is respondeat superior?
>>What is apparent authority?
>>What is corporate negligence liability?


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