How can I get the health insurance company to pay a bill?

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How can I get the health insurance company to pay a bill?

This is not the only time my husband’s health insurance company has done this. I was approved to have my neck fused at the end of December 2018. Fully understood that they accepted from the day of my surgery to the next day. Well I ended up with double pneumonia, 102 temp and needed oxygen. So I am getting ready to send out my second appeal to the insurance company. They have decided to deny not only the surgery they approved but all the medical after saying it was not medically necessary. I need to get rolling on this since it is a time sensitive matter. We are looking at being turned over to collections and the insurance company not paying close to $140,000. We have done everything we needed to met deductibles, paid all they we where suppose to pay and them some.

Asked on April 2, 2019 under Insurance Law, Colorado

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 3 years ago | Contributor

You can sue the insurer. Insurance of any kind is a contract, and the insurer is therefore contractually obligated to pay claims when the terms of the policy, as applied to the facts of the particular situation, say they should. If you believe they should pay under your policy but are not, you can sue them for "breach of contract": if you can prove in court that they should pay under the terms of the policy, the court can order payment. Generally, when someone does not honor their contractual or policy obligations, a lawsuit is the way to force them to do so.


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