Complaint 10 of 16 in “Claim Denied / Delayed in Whole or Part”
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- Insurance Carrier: Anthem
- State: ME
I was hospitalized late in February due to a severe depressive episode and suicidality. The insurance company refused to pay for most of my stay, though the doctor refused to release me due to the gravity of my condition. This despite three appeals by my doctor. I am wondering how to go about this, or better yet, how to avoid having to go this far.
Insurance Expert Answer:
As we assume the insurance was obtained thru a private employer's plan and thus it would be covered by ERISA, we have limited suggestions. There are rigid rules governing appeals, first within the system and then to court. The terms of the policy always govern. If a service is excluded from coverage the company will not pay for it. If the service is limited to X days, they will not pay for X+1 days. Best bet is to see if a lawyer in your area is interested.