Health Ins. benefits denial

[ckshaw87]

I reside in Utah. My spouse has attempted suicide twice this past year. The first time she was taking anti-depressants as perscribed by her OB/GYN. She was in therapy and seeing a Psychiatrist who monitored/perscribed her medications at the time of the second attempt. Our insurance has denied all medical treatment claims associated with the two attempts. It is stated in our policy manual that "intentionally inflicted injuries" are not covered. Our insurance has covered the psychiatric care (inpatient) required immediately after both attempts.

My wife indicated (by note) that she believed she was a burden to our family. It has been very damaging to her recovery knowing we are financially responsible for approx. $30K in medical bills. From a business standpoint I can understand our insurance companies position. However, if the attempts occurred while she was being treated for depression/mental illness, is there not an avenue I can pursue to have them cover the medical expenses incurred from the two suicide attempts? Would legal action be advised, or would I be wasting my time/money?

I have already unsuccessfully appealed their decison to deny coverage.
I appreciate any feedback.

 

[cbg]

If the policy manual specifically excludes coverage for intentional injuries, then I don't see a cause of action for you. I understand what you are saying, and I'm not saying I agree with having such a clause overall, but if it is there then they are within their rights not to pay it. About the only suggestion I can make is that you talk with your state insurance commissioner and see if there are any state mandated benefits that can help you.