My health insurance is denying a claim

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My health insurance is denying a claim

I had a heart attack on 2/24/18. The closest
hospital was not in the network and my
insurance company is denying payment. If I
had went on further 30 Miles to a hospital in
network, I would not be here because I was
there less than 10 minutes before I coded.

Asked on May 28, 2018 under Insurance Law, Tennessee

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 3 years ago | Contributor

An insurance policy, including health or medical insurance, is a contract. If you believe that the insurer is violating its obligations under the terms of the policy--that is, not paying a claim when the terms of the policy require them to pay--you can sue them for "breach of contract" to get the amount they should have paid. You can only force them to pay if by the policy's plain terms, they had to; if under the terms of the policy, they would not have to pay this claim, then they don't have to, no matter how unreasonable or unfair that is; that is, you can only enforce via lawsuit your rights and their obligations as set out in the policy.


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