Question:
i was denied by my ins. company. i wrote an appeal.can i sue them?

how can they decide if i live or die.    — leighrobi (posted on June 1, 2002)

June 1, 2002
Insurance companies have guidelines and regulations. Each company chooses what they cover and what they don't. If one company doesn't meet your needs, you go with another. If you are stuck with the one you have, for some reason, you have to follow their policies. They should have them clearly in writing. They don't "bend" them on an individual basis - they are "across the board" rules.....
   — Cathy J.

June 1, 2002
Actually your lawsuit would not be against the insurance agency but against your employer. They decide if the policy has an exclusion in it. After you've exhausted the appeals process I would certainly seek legal advice.
   — [Deactivated Member]

June 1, 2002
Some Insurance companies just don't pay for this surgery. Mine list WLS as an exclusion, unless medically necessary. However, I have heard that they have filed a motion with the department of insurance that as of next year, WLS will not be covered period! Why did they deny it? As a non covered service or not medically necessary? Good Luck!
   — Sharon H.

June 1, 2002
I am not a legal expert in any way, but it seems like the insurance companies can cover what they want or do not want to, as long as it is in a contract. What I have wondered about though, is when employers have a specific exclusion in their policy. Could this be considered discrimination? I have talked to the human resources person at my job, and if my secondary insurance does not approve me, we are going to upper management to discuss removing this exclusion. Never hurts to ask! Good luck to you!
   — Ginger N.