United Brachial Plexus Network, Inc.

I was wondering if anyone has ever considered or looked into suing their insurance company for failure to provide needed services, maybe there is a better term for it. Basically, my insurance company denied coverage to Sarah at what I would consider critical times in her recovery. From 11-12 months, from 18 months until she turned 2, at 2 we went with early intervention which did cover her until 3 and now I am having trouble getting them to allow her to have PT post surgical with a pt provider that has previously treated pediatric brachial plexus injuries. I am just curious. Maybe I am just frustrated. We did contact an attorney before Sarah was a year old but didn't follow through with anything because the umbilical cord was around/across the effected shoulder. I didn't think we'd have a chance. Now that they will cover the surgery but today denied the pt referral, I was just wondering if anyone has been in a similar situation and what they chose to do about it. Thanks for letting me vent. Mary

Hi,
I don't know a whole lot about this stuff, but I think that the new Patient's Bill Of Rights allows you to sue your Ins co. if they deny you coverage. We are just now in the process of getting our paperwork together for our lawsuit against the Dr., so maybe someone else can give you better insight. Good luck!

PT post surgery is a medical necessity.
Having lived my whole life with this injury, I am not afraid of insurance companies esp. since I know more about the injury than they do and I have never failed to get something approved. However that does not mean that you won't fail the first time. You may need to call and find out why and then ask what specifically what you need to do to make them understand that it is necessary. Your doctors, I am sure, would be willing to assist you with whatever letters/proof of necessity would be required. Most insurance companies have an appeal process. Just keep at it, don't give up.

Nancy

When my insurance company denied me, I appealed it and they denied me again with recommendations from doctors saying it was best to go to TCH. Ever since then, I will never go with another HMO. I hope you have better results.

Good Luck,
Adam

I had a problem with my insurance co too, but only because they wanted me to travel for therapy for my son when there is a childrens rehab center 5 minutes from my home. I wrote a letter explaining the need to go to a close facility (I have 3 children) and I sent in a picture of my son in his SOL splint and explained it would be uncomfortable for him to travel with the splint on. It worked, the insurance co contracted with the facility close to my home. My son was post mod quad so they had no problem approving all the therapy. Good luck