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Health insurance verbally approved coverage for mental health treatment, but now they are refusing to pay. Can I make them pay?

Los Angeles, CA |

I called my health insurance company to see if I could get therapy for anxiety and depression, and they told me yes and who to get it with. However, when the bills started to come in, they argued that it was a preexisting condition because I had already been taking a drug before. They said the first 6 months would not be covered, but after that it would be covered. Since 6 months had passed by this time, they told me I could go to therapy in the future, and it would be covered. Now they are refusing to pay for the sessions after 6 months as well, saying the preexisting clause is really for 1 year, not 6 months. They never told me about preexisting conditions when I first called for approval either. Is there any way I can hold them to their approval since I don't have anything in writing?

Attorney Answers 2

  1. Unfortunately, I'm not sure you can hold them to the authorization that they verbally told you. It is not like have the pre-authorization they send in writing to a provider that they will pay it before treatment starts. I would suggest you obtain a full copy of your health insurance plan to be sure what the requirements are, whether it is 6 mos or 1 year. Also your doctor may be able to help to state it was not pre-existing unless the medication you received was for this exact issue you sought treatment for. Once you have all the information, you may be able to appeal their denial of coverage. Good luck. Fortunately this issue will be null and void under the Affordable Care Act.

    This information provided does not create an attorney-client relationship and is for informational/educational information onlyl.


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