Q: 1 month old child had an air ambulance flight, insurance is denying the claim, can I pursue for coverage?
1 month old child experiencing breathing abnormalities and oxygen desaturation was flown from small mountain town hospital to major children's hospital for more acute care. Doctors at both hospitals gave order of medical necessity for flight, arguing other transport is not an option(3+ hr drive no traffic, 2 major mountain passes). Insurance claims, based on their own internal review, that the flight was not of medical necessity and has left us with the bill ($100k+). Do I have a case to get them to pay this claim?
First off, I hope to hear that your child is doing better after such a terrible and alarming medical scare. I can't imagine what you must have been through.
To your legal question, I think you might have a good case. A lot will depend on the language of your insurance policy and the reason's the insurance company is saying that it's not "medically necessary." I would recommend talking to an attorney who specializes in health insurance claims.
I'd be happy to look at the denial letter the insurance company has sent you and give you more in-depth advice. My contact information is below if you'd like me to take a look at the denial letter.
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