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My mental health insurance does not have an in network provider for autism testing for my son, I have to pay out of network.

Las Vegas, NV |

The only one that is in network has an 8 month waitlist for testing. They said I have to either wait the 120 days for them to contract for a new provider. Is this legal? I have no choice, it is my son's safety he is depressed and has lots of anxiety and I am worried about his safety what can I do. The supervisor does not return my calls, they are ignoring me. I told them to put it in writing in a letter and they refused. I asked for an email so I could memorialize the conversation and they said they do not have one. This is a large national health insurance company, United Healthcare. What can I do? I have to pay over $2,000 out of pocket for the testing.

Attorney Answers 2

Posted

How super that your son has such a champion to get him the care he needs! Keep it up!

Insurance is big business and they will fight you in any way they can. Every decision is a money decision for the insurer.

Firstly, in a situation like this, one would hope the insurance company would step up and do the right thing-but they hardly ever do!

Contact the division of insurance in your state. Let them know your situation and see if they can guide your through any of the claims handling regulations that may be applicable.

I would also contact an attorney who handles insurance litigation (there are some great ones in your area!) and see if you can get a consult. The reason an attorney would want to help you is simply to help-there is really (based upon what you described) no money in it for lawyer but I bet you can find an attorney to help you (draft a letter?) for free. I know I certainly do things like this a lot.

They should put it in writing their refusal/policy basis for their assertions. Ask the Div. of Insurance about a regulation for just that-any sort of claim denial or treatment denial or like must be in writing.

Do not talk to the insurer on the phone-you are smart to want it in writing.

Finally, does your area have an autism group? You may have already run this one out-but the group may have some insight. You may also wish to contact you legislator and apprise him or her of the issue. Get some heat on the insurer about the situation.

Keep at it and best of luck to you and your son!

This reply is not an attempt to solicit business. Tara Millan's reply is not to be considered a legal opinion regarding your inquiry. No attorney client relationship has been established with Millan's reply to your inquiry. Your matter is state specific and state laws and regulations most likely apply that are not mentioned in this reply. The information provided was in reply to a general question and cannot be relied upon as legal advice, nor does the information provided establish an attorney client relationship. Seek out an attorney with whom you can fully explain your unique situation and enter into an attorney client relationship with that attorney.

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Posted

The price of a policy is determined by what it covers--the more it covers, the more it costs to provide, and therefore the more it costs.

Networks are a cost reduction matter; some policies have them, and others don't. They keep costs down by using providers that agree to their fee schedule.

There are certain things that are required to be covered by state law (and each one makes the cost of every policy higher, and excludes more people from having insurance at all). These must be covered. Everything else that is cover is a matter of the insurance contract.

There is no requirement to pay for uncovered siply based upon need.

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