Alexandria, VA asked in Personal Injury and Insurance Bad Faith for Pennsylvania

Q: I have Aflac and was denied accident, hospital and critical illness claims after I have a miscarriage at 12 weeks.

was hospitalized( was admitted), and given an emergency blood transfusion. Was this not an accident? Is needing a stat blood transfusion critical? And I was admitted to the hospital but because I wasn't there 24 hours they denied that claim as well?

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

A: A Pennsylvania attorney could advise best, but your question remains open for two weeks. And it's possible that time could be of the essence in responding to the denial. I am very sorry for your ordeal.

The short answer is that an attorney consult could be valuable here, unless you are experienced in dealing with healthcare denials. Review the denial carefully and see what your deadlines for responding are, and if options are outlined - in terms of reconsideration, appeal, file for arbitration, file civil suit, etc.

I'm sorry that it isn't possible to offer meaningful direction beyond that. An experienced attorney would need to review the policy, its definitions, your patient chart, etc. The physicians in the hospital could be your allies here, if it turns out to be a matter of relying on them to attest to the medical necessity of the procedures administered.

These are only some general points. A consult with a Pennsylvania attorney versed in health care claims should be able to provide more detailed and specific guidance. I hope you are able to resolve the matter. Good luck

Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.

The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.

Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.