Big Bear, CA asked in Insurance Bad Faith and Insurance Defense for California

Q: Am I entitled to reimbursement if I had to purchase out of pocket to a medical supply company that is not in my network?

Because of a nation wide shortage of said medical device, I was forced to find this device on my own that was not within my Insurance network. If device wasn't obtained, I would have been placed out of work until device was obtained.

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

A: A California attorney could advise best, but your question remains open for two weeks. Going strictly by the terms of the policy, it's possible you might not be entitled to reimbursement. No one here could know for certain. But these types of situations SOMETIMES have room for discretion on the part of the carrier, on a case-by-case. There are no guarantees. It could depend on the type of insurance involved, the individual examiner, the insurance carrier, the cost of the device, how it was medically necessity or how it met an occupational accommodation, and other possible factors, such as the national shortage you mention. You could reach out to California attorneys to review more meaningfully, with the benefit of a denial, EOB, peer review (if they were issued), medical records, and additional information about the device, and how the device was necessary to accommodate a restriction or disability. Good luck

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