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

UPDATED: Aug 9, 2011

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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


Stan Helinski / McKinley Law Group

Answered 11 years ago | Contributor

What was the basis for denial? 

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

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