When an insurance coverage invoice for medical companies comes within the mail, many individuals open the envelope with a sense of dread, not figuring out what proportion of their current medical remedy might be coated by medical insurance and the way a lot they’ll owe out of pocket. That bill might be for $20, $250, and even $25,000 or extra. When our shopper opened her mail, she was shocked to see a hospital invoice stating she owed $39,000 out of pocket. Nevertheless, beneath the phrases of her ERISA-governed medical insurance plan, she mustn’t have been charged something. Our workforce at Donahue & Horrow LLP fought again and ensured our shopper is not going to be chased by invoice collectors looking for cost of the bill.
In Might 2021, our shopper was experiencing extreme complications and blurry imaginative and prescient. She first went to a walk-in clinic and was then referred to the Emergency Room. Ultimately, she was admitted to the hospital for testing and statement. On the path of her physicians, our shopper underwent an echocardiogram with bubble examine, an MRI (Magnetic Resonance Imaging), a CTA (Computed Tomography Angiography) and different procedures. No points had been discovered so she was discharged from the hospital. Lower than every week later our shopper realized that her medical insurance declare for the in-patient hospitalization was denied on the grounds that the hospitalization and testing weren’t “medically essential,” as a result of no issues had been recognized. In fact, that declare choice didn’t make sense as a result of it was solely by the hospitalization and testing that the docs had been capable of clear and discharge her.
Our shopper went by the onerous, multi-level enchantment course of, offering a timeline of occasions and defined that it could have been under the usual of take care of the ER to discharge her with out the outcomes from the testing that was carried out throughout the hospitalization. She additionally defined that she underwent the hospitalization and testing on the suggestion of her docs, not as a result of she was insisting on testing in opposition to her physician’s directions. But the corporate that was dealing with the insurance coverage declare for the ERISA plan nonetheless refused to acknowledge that the hospitalization and testing had been medically essential.
When our shopper contacted Donahue & Horrow LLP, we agreed to file a Federal ERISA lawsuit within the Los Angeles courthouse of the Central District of California on her behalf. Within the lawsuit, we requested the Court docket to affirm that she didn’t owe the insurance coverage plan any cash, and that the plan pay her attorneys’ charges and prices. Ultimately, the events performed a mediation at which a settlement was reached. Whereas the phrases of the settlement are confidential, our shopper was very happy with the end result.
The attorneys at Donahue & Horrow LLP have a long time of expertise litigating insurance coverage advantages disputes, together with claims made beneath ERISA-governed incapacity insurance coverage, life insurance coverage, AD&D and medical insurance plans. Should you imagine that your insurance coverage declare was improperly denied, name Donahue & Horrow LLP at (877) 664-5407 for a free session.