Health Care Insurance Claims and How They Affect Your Health
You are more likely to get struck by lightning than to get an insurance company to pay for a major medical procedure. For those of you who have seen the movie, “Rainmaker,” you may remember the corporate giant, Great Benefits, getting sued by Rudy Baylor, a young inexperienced attorney doing what he thought was right. In that movie, Great Benefits, an insurance company was being sued for denying a policy inclusive procedure to a young man with leukemia, leading to his death. Unfortunately, these occurrences happen just as often in real life, with individuals suffering very real consequences.
Recently, the family of a seventeen-year-old leukemia patient, Nataline Sarkisyan, sued Cigna, a major health insurance provider, when the company refused to pay for a liver transplant. As a result, the teenager died and there’s no bringing her back. Nataline’s family asked Cigna to pay for a liver transplant but the insurer refused, calling the procedure experimental. Four doctors subsequently pleaded with Cigna to reconsider, stating that individuals who receive the transplant have a six-month survival rate of 65%. After extensive rallying by health care providers outside of Cigna’s office, the company reversed its earlier decision, but it was too late. Nataline Sarkisyan died within hours.
Although Nataline’s lawsuit is taking place in California, there are statutory provisions in place to protect individuals like Nataline in Minnesota. Pursuant to Minnesota Statute 604.18, an insurer is liable to the insured if the insured can show:
1.) The absence of a reasonable basis for denying the benefits of the insurance policy; and
2.) That the insurer knew of the lack of a reasonable basis for denying the benefits of the insurance policy or acted in reckless disregard of the lack of a reasonable basis for denying the benefits of the insurance policy.
Health care has changed immensely in the past twenty years, and these changes have had both positive and negative implications on the consumer. It is vital to ask questions before you purchase your policy and read the fine print. The insurance agent can be helpful with explaining certain features to your policy, but he or she is not the person denying or approving your plan when you need it. The relationship you have with your insurance company is purely based on the terms stated on your policy-nothing more and nothing less. It is wise to shop around, get to know the major providers, know their payment systems and understand the exceptions to the policy. Almost every insurance policy lists what they cover, followed by the exceptions or limitations. This is crucial, so do not overlook this section.
If you or someone you know has been wrongfully denied coverage by the insurance company, I recommend contacting a competent attorney to understand your legal rights in the matter.
For More Information See: Calif. Teen’s Family Sues Cigna Over Transplant
***DISCLAIMER: The content provided is not intended to be construed as legal advice. If you have any questions or concerns, based on your factual circumstances, please contact Richard Y. Cheng, Esq. with Pearson, Randall, Schumacher & LaBore, P.A. (612)767-7500 or rcheng@prslegal.com***