Medical Malpractice Attorneys and Lawyers

Does anyone have advice regarding medical insurer denying claims?

Yes, I'm aware that this is R&S, but I am more familiar with people here. This is for my 11-year-old son. We were denied a claim on Friday. They won't cover prescription medication that we cannot afford ($1,800/month). The pharmaceutical company that is filling the prescription has offered to do the appeal for us. Since they have a medical team and attorneys, we're going to let them fight the battle. My question is --- is this a wise course? Should we try to take this on ourselves? If you have any experience or advice, we'd appreciate it. Thank you all for your words. And Walkin Dude, if you talk to your attorney friend, I'd love to hear his opinion.

Public Comments

1. You might go ahead and consult a lawyer anyway. It's always better to have someone on your side.
2. An appeal will cost and if the pharmaceutical company offers to help that would be my approach for the time being. If that doesn't produce a good result, then I would take them on. Good luck!
3. As a visitor to the US, I love it but your medical system sure does suck. In Australia are drugs are subsidised so we would pay no more than about $30
4. I am sorry I cant help with your question laptop... but this angers me so much people are being denied medicines or having to get into debt for medicines ... in what is supposed to be a civilised world ggrrr same here in UK Jason our hospitals are free and our prescriptions are cheap
5. let the drug company fight. frankly, i don't think the insurers bother listening to individuals.
6. yeah, I would take the help of the pharmaceutical company but with caution. see if you can get a sort of plan or outline of what they're going to do exactly. if that doesn't work out for you, see if you can get some prescription assistance. when all else fails, consult your own attorney (which can be costly for a good lawyer). montell williams endorses some sort of prescription assistance program. I'm not sure if it's for seniors or for everyone who needs regular prescriptions. I forgot the name, but google his name and you should find the information. hope this helps. good luck to ya.
7. This is crazy....the world needs to see these things on television, not some news story about arson or other crimes. Greed is blinding us and preventing our growth as a society. We should be able to get the proper medical care and other necessities of life to people who really need it. Instead, we're bogged down by corporate profits and returns on investments. Surely as a society we can all gather to take care of one another....I just haven't figured out how to do that collectively....yet, that is. Peace, Love, and Blessings Greenwood
8. I would first have the doctor send a letter & call the insurance company. I am a RN, the people who deny these claims, they are not always medically trained & are just following standard orders. Many times, if the med is medically necessary a letter & call from the docror will do it. These case workers also have supervisors, always ask to speak to their supervvisor. I would wait on the attorney till you try this first.
9. You should be as actively involved as you are able to. If the pharmaceutical company is willing to fight the battle for oyu great, but make sure they keep you informed. You did not say why the claim was denied- if oyu do not know, find out - it could be something as simple and stupid as a typo. I had a prescrition denied once because they typed in my date of coverage as two years in the future. We did not just accept the denial, after investigating, we found it was s simple silly mistake, it was taken care of and we were reimbursed. Unfortunately, the same mistake was made about a year later and it was for a 2 day hospital stay- because of miscommunication we did not know until a year later that the claim was denied and the hospital expected us to pay. We thought everything was covered as the doctors, labs, anesthesiologist , etc that I saw those same two days had already been paid- it was only on hte hospital billing that the mistake was made and payment was not made. It wound up costing us a lot because we were not well informed and part of that was our fault. Keep good records, make calls to the insurance company, write down who you talk to and exactly why they say you are not covered. Call the pharmaceutical company regularly and find out where things stand. They are dealing with a lot so you are just a number and paperwork to them- so make sure they know you and know you are keeping on top of what is going on. Taking it on yourself may wind up costing more than the prescription and if it turns out to be a simple fix, it would not have been worth it to you in the long run.
10. I'll ask my lawyer buddy. I seem to remember him telling me that people often get better results when they go to the local media. If this is really offensive, it could catch on with the national media. Investigate everything you can before you sign anything. I might even try to email Michael Moore (if you can). His new movie, Sicko, is on how screwed the health care is in America. When corrupt people see Michael Moore coming, they start to sweat. If you get the support of the public, through the media, then they might try to shut you up. Good Luck.
11. Cancer patient here. Which of course means that I pretty much know everyone in my insurance office on a first name basis. You of course can appeal it through your insurance company... but it's always fruitless. They don't want to pay! And as long as they can simply keep sending you a little note that says, "Sorry, but you're on your own. We only stick with people who pay us money but don't need us," they will do exactly that. They only allow you to appeal through them because it feeds the illusion that you actually have some say in the matter. Here's some options for you. Firstly, is there a generic version of the drug that your insurance WILL cover? Ask the doctor or pharmasist on this one. If so, get those wheels spinning it that direction if at all possible. Or at least call the insurance company and ask if their denial is based off of dosages (perhaps the perscription exceeded the dosage limit of what they'll cover... you could try filling it for half a month instead of the full month, at one time). You can also hire an attorney to fight the appeal for you. It's spendy in and of itself, but if your son is going to need this medication on a regular basis, it's well worth doing. Most attorneys offer free consultations if you'd simply like to talk to one and see what your legal options are--so make use of them, and bring copies of your insurance policy (even your handbook, if you have one) with you. Also, discuss pre-existing condition clauses should you decide to get a new insurance policy elsewhere. Because of the actions of HIPAA, many states have laws against new carriers denying claims for a pre-existing condition if you haven't had much of a lapse of insurance coverage. You may consider adding a secondary coverage using your spouse's insurance (if she has any), or even from yourself if your son is actually under her coverage... does that make any sense? It confused me! Finally, if all else fails, ask to speak to a hospital financial officer or social worker. You may be surprised at what programs are availible to you--but most social workers won't answer very in-depth without specific questions from you. There are charities out there (even some drug companies have special rates or offers to those not able to afford standard rates), but if everyone knew about them, everyone would use them regardless of their ability to pay. More? DON'T EVER GIVE UP. It's frustrating, but keep beating away at this until you find something liveable. Depending on your son's condition, you might even find aid through groups that specialize in awareness. (Leukemia and Lymphoma Society would be one example for those with blood cancers.) Keep turning over rocks. I can't stress this enough.
12. Oh no! I don't know Laptop, but I sure hope it works out for your family!! (((Laptop)))
13. Goddamn health care industry..... seriously, I hate it. HATE IT. You don't know how many I was when I read this. I mean, obviously you're much more upset considering this is your son, this is happening in your world, in your life, but to a lesser degree I'm mad like you are because when you talked to me about your son and how you want the best for him and hope that you can better his situation, I was let into that situation and I care about what happens to him in my own distant, disconnected way. I also keep thinking that this is going to be my son's situation. Everyone always comments on how small and skinny he is and of course being the paranoid freak that I am assume that he's going to be small and skinny for years to come. So really I'm concerned because I'm also making this my hypothetical problem. It's both genuine outrage at his situation and a whispering voice telling me that it'll happen to my son too. I wish I could give you some magic super-solution but... I can't. I think everyone above had some great ideas and suggestions. Yes I think you should contact a lawyer and at least get that free consultation in order to mull over your legal options. And yes, I really do think you should take this to local media if you can, if they're interested in the story. Public perception is a powerful weapon! I really really really really hope everything works out. I so much want your son to be happy, and I want you to see him happy.
14. First, you need to find out exactly why they are denying the prescription. Second, talk to the doctor, he may be able to prescribe something else. Third, work with the pharmamucetical company. They know how to deal with the insurance companies and even if the insurance company does end up denying the medicine if you have a history with the drug company they may still be able to help you. good luck.!