Saw a specialist for about a year plus, went through all the diagnostics with the understanding that I would be receiving treatment after 6 months. It is now well over that time frame. I was just told I was denied treatment by Medicaid. My provider knew or should have known that I would have been denied treatment from the beginning based on Medicaid criteria in my state which I was not aware of but they deal with insurance all the time and should have known the rules. I was NEVER once told I might be denied I was told I would receive treatment and never that I would have to pay for it. I am low income, Medicaid and can not afford the medication. I am now expected to wait until I am seriously ill, potentially dying before I can get treatment. If I got treatment now, like I was told I would, I have 97% chance for cure. Do I have a case
Such a failure to know and report to you what your insurance does and does not cover is not a basis for negligence/malpractice.
Dr. Zaheer A. Shah, MD, JD (Attorney and Physician): The author of this answer is an Attorney-at-Law, licensed to practice law in the state of Arizona and he is a board certified, Ivy League trained, practicing physician. Nothing posted on this forum by the author constitutes legal advice. Additionally, any medical opinions rendered on this forum in response to a particular question do not constitute medical advice. Opinions expressed herein are solely those of the author, and are neither privileged nor confidential. While an effort is made to offer accurate information, there is no guarantee as to accuracy.
Doctors practice medicine, not finances and insurance. It is not medical malpractice if your doctor recommended a course of treatment that Medicaid does not cover.
I doubt it. However, there could be an appeal process by which the Medicaid decision to deny coverage can be reviewed. I'd try to get in touch with Medicaid and ask what your options are for this treatment.
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