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Insurer denies recommended treatment for child cancer victim

On Behalf of | Nov 4, 2017 | Denied Insurance Claims

Reasonable people in Oklahoma and across the country likely wonder fairly routinely just how some insurance companies survive ill-advised actions and comments directed toward policyholders.

Sometimes it is a coverage denial that can seem so grounded in bad faith or illogic that it incenses most individuals who hear about it. On other occasions, an insurer’s sheer insensitivity it what most rankles.

And sometimes it is both those things.

Take a recent news story involving New York insurer HIP, for example. Its details are both notable and sadly troubling.

A letter sent by HIP addressed the clinical trial an insured party was participating in as a latter-stage aggressive protocol to treat progressively spreading cancer.

The insured is the nine-month-old son of a retired police officer being treated at a St. Jude Children’s Research Hospital. St. Jude’s is known globally for its cutting-edge therapies and efforts to consistently improve care for child cancer victims. Its staff deemed the clinical trial and select balancing of medications that doctors prescribed as vitally important for the infant.

HIP expressed a contrasting view in a letter it addressed directly to the child rather than his parents. In an official and even sterile-sounding communication, it concluded that the trial and combination of medicines constituted unnecessary treatment lacking evidence “to confirm its effectiveness.” It denied the claim.

Even though St. Jude’s provides care free of charge, the father is still concerned that the denial unfairly challenges a world-renowned facility that is a leader in fighting children’s cancer.

We implicitly note such cases on our website at Mansell, Engel & Cole, stating therein that it is common for an insurer’s claim denial to be based on “a biased position without full knowledge of [a patient’s] condition.”

We fight back against that response on behalf of policyholders who receive sound and well-reasoned information from doctors that is refuted from a distance by an insurer’s in-house stuff.

We welcome contacts to our firm and the opportunity to discuss the work we do to promote the interests of insured parties confronting unreasonable challenge from insurance companies.