Can I appeal a medical procedure denied regardless of medical necessity? Denial of procedure insurance company's policies indicate is appropriate
Question Details: Denied a procedure to cure obstructive sleep apnea because there is a blanket exclusion of this procedure in the policy. Their own medical policy in general considers it appropriate. Benefits also list it as one possible surgery. Have to search exclusions to find it. OSA is not addressed specifically in policy.
Insurance Law Law Answers
If you have something in writing from the insurance company that lists the procedure as something they would pay, you need to take that (and the rest of your claim paperwork) to a lawyer's office, because there might be something you can do about this.
In most state, insurance law says that a clearly written exclusion will be enforced -- but it also says that if the insurance company says two opposite things, the one that is best for the insured person is what controls.
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