If my doctor has provided my insurer with documents stating that it is necessary tI have a diabetic pod to sustain life, can it refuse coverage?
Get Legal Help Today
Compare Quotes From Top Companies and Save
Secured with SHA-256 Encryption
If my doctor has provided my insurer with documents stating that it is necessary tI have a diabetic pod to sustain life, can it refuse coverage?
Asked on February 3, 2014 under Insurance Law, Oklahoma
Answers:
SJZ, Member, New York Bar / FreeAdvice Contributing Attorney
Answered 10 years ago | Contributor
Yes, it may refuse coverage if:
1) your policy does not cover devices/procedures like that;
2) if the diabetic pod is considered "experimental" treatment (I don't know anything about diabetes, so I have no idea if this would be the case)
3) if it believes that you don't actually need it--the insurer is not required to take anything a doctor prescribes at face value, if, for example, it has reason to believe the procedure is not actually necessary
However, you do not have to take the insurer's determination at face value, either: if you feel the insurer is not paying for something which it should, under the terms of your coverage, you could sue it to try to force it to pay, and a court/judge will determine if this device/procedure is covered in your case.
IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.