Law regarding insurance company pre-approval

[geister]

Hello, I am interested in finding out if there is such a law in effect today that states that an insurance company can deny your preapproval rights. My husband is supposed to have a new non-invasive heart surgery and the company will not tell us if we will be denied or they will pay. This is really stupid as I relayed to the insurance company today . It is totally non-invasive and is highly successful and would cost much less than open heart surgery! The success rate is tremendous at the Cleveland Clinic in OH. The problem is that the insurance company will not accept our appeal because he hasnt had the surgery. I can accept this, but I CANT accept the fact that they wont deny OR accept anything BEFORE we have it! This absolutely makes no sense at all. Am I right? My only recourse is to pay for the 20-30,000 surgery myself which is out of the question because I am a stay at home mom (for now, that is if my husband doesnt die first), OR Have open heart surgery which will be covered totally and much more expensive. My husband is a terrific guy but refuses to have someone cut into him if he has an alternative route. I cant blame him. Thats why I am PLEADING with you to tell me if we have a choice. I am so grateful to all of youfor taking your personal time to give this advice. Thanks
Also, if there is NO such law, any advice on how we can beat this stupid system?!

 

[lawrat]

I am a law school graduate. What I offer is mere information, not to be construed as forming an attorney client relationship.


That is a very good question. I am not a health care or insurance expert, but the following sites may help you, or get you one step closer.
http://www.mrmib.ca.gov/index.html
http://www.hcfa.gov/