If you have been denied coverage by your health insurance provider for breast cancer treatment or services prescribed by your doctor, you can appeal the decision.
Legal Issues and Health Insurance
A health insurance company’s decision about insurance coverage for breast cancer treatment and services is often based on the cost of the service, rather than on what the patient’s doctor prescribes as medically appropriate and necessary. Most health insurance companies are businesses committed to their own interests. You must be equally prepared to represent and protect your interests.
Breast cancer patients are sometimes unaware that they can appeal an insurance company’s decision to deny coverage. Also, women (and men) in this situation may seek expert advice too late—after they have exhausted the appeals that a knowledgeable advocate or lawyer may have been able to pursue successfully. If the appeal was related to treatment, and an individual is not able to pay out-of-pocket, this situation could affect survival.
If you have been denied coverage and your life or health is in jeopardy, you should consider consulting a lawyer who is knowledgeable about health insurance law. A letter from a lawyer or consumer advocate is often taken more seriously by health insurance companies than a letter from a patient. These letters can sometimes speed up reversing a denial of coverage.
If you cannot afford a lawyer, look for a pro bono attorney (attorneys who provide their service at no cost or at reduced cost) or contact a consumer advocacy group. See the Resources at end of this section.
Also, see Insurance Issues section for more tips about how to appeal a denial of coverage with a health insurance company.