My health insurance is denying a claim

UPDATED: Oct 1, 2022

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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


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 4 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.

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 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.

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