Denial of service

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Denial of service

I have been dealing with my insurance company for over 2 months now. They are refusing coverage for my sons occupational therapy. They keep telling me that it needs to be adjusted because he also receives speech services at the same clinic so the insurance company is bundling the 2 together when in fact it’s 2 completely separate service. My plan includes occupational therapy and speech therapy. I called to verify benefits before we started. What are my options at this point?

Asked on June 18, 2019 under Insurance Law, Michigan

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 2 years ago | Contributor

Ultimately, if you and they cannot resolve this to your satisfaction, your recourse would be to sue your insurer for "breach of contract" to get the extra payments or coverage. An insurance police is a contract, and the insurer is therefore legally obligated to provide the coverage that the policy says that do. If they are violating your reading or interpretation of the policy, you would sue them for breach of contract; if you can convince a court of your interpretation, the court can order payment of charges incurred to date and coverage going forward.


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