Does your health insurance company have the right to discriminate and go against your doctors care?
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Does your health insurance company have the right to discriminate and go against your doctors care?
My spinal surgeon says that I need lumbar fusion surgery and insurance refuses claim.
Asked on November 5, 2012 under Insurance Law, Tennessee
Answers:
SJZ, Member, New York Bar / FreeAdvice Contributing Attorney
Answered 11 years ago | Contributor
Your insurer does not have to pay for any and every procedure. Insurers can decline to pay if they believe that the procedure is inappropriate, unproven, not helpful, etc. That does not mean they are right to do so in this case, only that circumstances exist under which they may refuse. You should consult with an attorney, preferably one with health care/health insurance experience, to see if you have grounds to force your insurer to pay in this case.
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