San Diego, CA asked in Insurance Bad Faith and Health Care Law for California

Q: My husband had back surgery 1 year ago. Our insurance gave authorization but now have denied the claim. We have 67K bill

My husband has double insurance coverage. 1 policy through his work (Grossmont Union High School district) and 1 policy through my work (San Diego Unified School District). He went through my policy and was originally given authorization for the back surgery. Now the insurance company is sending us a bill for $67,000. What should we do?

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. One option is to reach out to attorneys who handle health care claims. First, try to compile a complete file on the denial and its supporting documentation, such as EOBs. Also put together all the documentation you have on the pre-authorization. If medical necessity is any part of the basis of the denial, obtain copies of peer reviews or other medical opinions on which the denial is based. Two weeks have already gone by - review the small fine print on the back of the denials for timetables for appeals, filing suit, arbitration, or other options. Given the amount at stake, the investment in consulting with an experienced attorney here could be worthwhile. Good luck

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