Can an insurance company approve a procedure and then deny it after it has already been performed?

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Can an insurance company approve a procedure and then deny it after it has already been performed?

Our insurer gave my son’s oral surgeon the OK to remove his wisdom teeth. They even paid for the consultation fee. When the doctor’s office billed them after the procedure, our insurance company said that it was not covered. I am now stuck with a bill for $2186.50. The insurer has a recorded message when the service rep told the doctor’s office that procedure was covered. The paperwork has been resubmitted. I am waiting on a final decision. In the event that it is denied, do I have any legal options?

Asked on August 9, 2011 Massachusetts

Answers:

Stan Helinski / McKinley Law Group

Answered 10 years ago | Contributor

What was the basis for denial? 


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