I will attempt to convey details as concisely as possible.
I had a deformation in my jaw resulting in evolving sleep apnea and also induced a speech impediment. The severity of the deformation required surgery.
When speaking with my insurance, they denied two appeals seeking coverage of said surgery.
I then engaged in a teleconference with a surgeon of the insurance company, my surgeon, myself, and an insurance representative.
I later received documentation from the insurance company noting that the decision to overturn the denial for coverage had been met.
I had the surgery last year and my insurance paid $72k for the hospital stay however refuse to pay for the procedure itself which was $14k and is soon going to collections.
Any advice would be much appreciated.
This is obviously a factually complex situation that requires review of all the documentation involved. But I don't think any lawyer would advise anyone to sue a "major health insurance company" for $14,000, especially when that insurer has paid several times that amount for related coverage. You need to see your own litigator to get a more personalized response.
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The first place I would look would be the insurance policy terms for appealing an adverse decision. Pay special attention to time deadlines.
I think that suing to recover $14 where the company paid $72 will be an uphill battle, and trying to do so without an attorney - - even more so.
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