Do you ever wonder what justifications insurers use for denying mental health benefits? In our experience, we have come to learn that the reasoning behind these types of insurance denials can be incredibly shocking. Some insurers have the ability to make tragic, life-threatening behaviors seem insignificant and trivial.
For instance, below are a few recent insurance denials we have encountered:
- "You haven't cut yourself in the past few days."
- "We cannot approve the request for admission to partial hospital care. After binge eating you purge 45 times per day. You have had this pattern of eating behaviors for a while. You are not doing worse and not likely to need hospital care soon." (Yes, 45 times per day! Not a typo.)
- "You have suicidal thoughts, but no plan."
It's interesting that insurance companies follow this nonsensical philosophy in making decisions. Shouldn't the types of behaviors (mentioned above) demand further support and treatment- rather than less?
When dealing with insurance companies, you must also be aware of the not so "independent" medical reviewers. An Independent Medical Exam ("IME") is often arranged by the insurance company during a health insurance claim. This is an exam arranged by the insurance company, usually with an expected outcome… support for a claim denial. There is rarely anything "independent" about these exams. The credentials for these internal (and even external) reviewers are not always clear, and it is possible for them to contribute to an insurance denial without possessing much medical or disease-specific knowledge of your case.
Recently, our firm was involved a case where three separate doctors were all contracted to perform "independent" reviews for an insurance carrier on the same claim. The three "independent" doctors consisted of a father, his daughter, and his live-in girlfriend. Shockingly, all three doctors reached the exact same conclusion…independently of course.
How far are insurance companies willing to go to avoid paying a claim? It is not uncommon to find insurance companies who will deny claims to boost their bottom line,
insurance companies who will reward employees for denying claims,
and insurance companies who will effortlessly replace employees who will not participate in unjust insurance denials. Thankfully, there is a team of dedicated professionals whose sole mission is to level the playing field. Remember that in insurance denial is NOT the final word.
If you have been denied benefits for the treatment of your eating disorder, please do not hesitate to reach out to Kantor & Kantor, LLP for a no cost consultation.
We understand, and we can help.
www.kantorlaw.net (800) 446-7529