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Employer health insurance

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rmcdannell

Junior Member
What is the name of your state? WI

I am covered with health insurance through my husband's employer. There is a surgery that I need desperately that the insurance states it does not cover. It is not cosmetic and I have exhausted all appeals with the help of my Doctors. I have even appealed and begged to my husband;s emplyer and they stated they use to cover the surgery but no longer do and will not approve it. My Doctor;s are stating I need this because my organs are starting to shut down. Is there anyway we can force the insurance to cover it? It is a matter of life and death.

Thank you.
 


Beth3

Senior Member
You don't say on what basis the insurance company is denying the coverage but I'm guessing it's that they consider the surgery experimental.

If you have exhausted all internal appeals with the carrier and you believe that under the terms of the insurance policy it should be covered, then your next step is to file a complaint with your State's Office of the Insurance Commissioner.
 

cbg

I'm a Northern Girl
BTW, if the specific procedure is listed in the policy under Exclusions, then no, there is no way you can force them to pay for it. You can certainly try to persuade them otherwise but they have no legal obligation to pay for something that is excluded under the contract, regardless of how necessary it may be. The law does not say that if it's medically necessary the insurance has to pay for it, regardless.

If it is not specifically listed as an exclusion then you will need to post more information; specifically, on what basis they are denying coverage.
 

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