Silverdale, WA asked in Health Care Law and Insurance Bad Faith for Washington

Q: How do you sue a health insurance company that is regulated by the CCIIO?

My partner has been denied coverage for a severe neck issue because her symptoms do not meet the criteria for medical necessity.

Her doctor, however, believes that she does met that criteria.

1 Lawyer Answer
Tim Akpinar
Tim Akpinar
  • Insurance Claims Lawyer
  • Little Neck, NY

A: A Washington attorney could advise best, but your question remains open for a week, and it appears that your partner is in need of medical attention. Only a local attorney could advise on civil procedure aspects of suing insurance carriers in terms of the question you pose. But some general considerations you could look into are whether the denial outlines other options. Depending on state law and consumer law, some options could include arbitration, appeal, civil court, or other recourses. Additionally, you could check with the claims examiner if they would reconsider their position on the denial with supporting documentation from your doctor. A local attorney familiar with health care denials and who has firsthand experience with the particular carrier would be able to offer more detailed guidance. Good luck

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