Q: Insurance company denied medically necessary breast reduction. My back is now more damaged. Can I sue?
Hi,
I have a very large chest and as such I also suffer from crippling back pain. It has gotten to the point I can no longer function normally and cannot even get out of bed some days due to sciatica. I tried to get my insurance company to pay for a breast reduction and they denied me. In this time while I was waiting for them to pay and was denied my back got even worse and there is evidence of this through scans. Is it possible to sue them since they refused to pay for something that is medically necessary and should be covered and their denial of this surgery caused my back to get even worse. Do I have a case?
Thanks
A:
I'm sorry for your ordeal with the back pain. In terms of having a case on which to sue, a law firm could offer a more meaningful response after reviewing the file with the input of medical professionals. What you are really probably wondering is whether you could sue in a manner where a law firm would handle your case on a contingency basis (no win - no fee), not an arrangement where you pursue the matter paying a law firm on an hourly basis.
There are questions that a law firm would need to sort out. What are the provisions of your insurance policy? Are remedies for appeal or arbitration outlined? What is your medical history? Did you explore having an orthopedic surgeon or other medical professional help prepare a response to the insurance carrier's denial arguing for the medical necessity of surgery? The answers to some of these questions could require opinions from orthopedic surgeons, radiologists, or other medical specialists.
To get a meaningful answer to your question, you could reach out to law firms to discuss in further detail. Good luck
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