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Your insurer preapproved you: It’s a done deal … right?

On Behalf of | Aug 13, 2018 | Denied Insurance Claims

No reasonable individual in Oklahoma or elsewhere willingly proceeds with medical treatment these days without first asking a pointed question of his or her insurance carrier.

That is this: Is it preapproved?

That is the Holy Grail of all insurance-linked queries. If it’s approved, you just might get what you need without dire financial downsides attached. If not, well … .

That might seem like a zero-sum game, but it is at least something comprehensible – if not always fair – to work with.

Here’s a question to mull over from what must seemingly be an alternative universe, though: What if you receive written notification from an insurer that specified treatment is covered, but are later stiffed by the carrier for reasons it never addressed in its approval communication?

Is that even comprehensible?

We’ll try again. The insurer preapproves your treatment without any stated limitations, but then later hands you the bill because you didn’t comply with conditions it never explained in the first place.

Is that better?

We didn’t think so. It certainly didn’t satisfy a couple stuck with a $21,000 outlay for a Stage 3 cancer chemotherapy drug that was unconditionally approved by Anthem Blue Cross and Blue Shield. The company beamed in mid-treatment with a host of conditions that it had not mentioned in its initial qualifying letter.

The couple turned to a reporter from a major media outlet to get some answers from Anthem. That writer professed to being flatly baffled by the insurer’s “downright absurd reasoning” and behavior that seemed “inconsiderate to the point of cruelty.”

Anthem eventually backtracked from its inexplicable stance and coughed up the money it contractually owed the care provider.

Notwithstanding that positive result, though, the story raises a fundamentally troubling point. The reporter expresses it in his telling of the tale, writing that “no one should have to rely on the press to resolve an insurance matter – especially when the insurance company is at fault.”

Proven insurance attorneys who advocate solely and diligently on behalf of policyholders denied fair treatment by insurers emphatically endorse that view.

And, in fact, aggrieved insureds don’t have to pursue such a route in search of equity. Questions or concerns regarding an insurer’s bad-faith conduct – denial, delay, underpayment or anything else – can be directed to experienced pro-policyholder attorneys.