Our health insurance isn't paying - how can I make them - take them to court?

Question

Do I take it to small claims court? How do I go about doing this? Is there a way to start online?

Answer 1

You will need to hire a lawyer.  This would not be a small claims issue.

Answer 2

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Answer 3

Nope, it's not small claims for contract stuff.  You'd have to hire a lawyer.

But that shouldn't be your first step.  First, you should appeal the denial, in writing.  That means, referencing your policy, you need to say why they are wrong about not paying your claim.  Second step, if they deny again, is to complain in writing to your state insurance commissioner, including all the documentation about what your policy says it will cover, and the denial letters about what they are refusing to cover, and why there's a conflict.

You want to do the court thing last, because you'll have to hire the lawyer - at about $200 an hour - and if you win, of course you'll ask for court costs, but if you lose, well, the lawyer fees will likely exceed the bill, seeing as how you were mentioning small claims court.

Answer 4

Hi, before you proceed to hire a lawyer, read your health insurance contract, and highlight the areas on a photocopy you believe you're able to claim.(* the original must never be defaced*) The wordings may sometimes be difficult to interpret for the layman.  Your agent should help with your claim, failing which  the manager of the insurance company you bought the policy from.

I don't know which part of the world you live, however there should be a Govt body you can submit a complaint to, supported by evidence of  the rejection by the insurer. Also, the consumer agency can take up your complaint. The amount of your claim will determine if it is to be filed under the small claims court. Personally, going to court always takes a lot of frustrating time. However, if you are unable to afford a lawyer and strongly believe you have a strong case, you can seek the help of NGO's  who normally have a panel of lawyers who contribute their time voluntarily. Goodluck

Answer 5

Well, there are certain steps that would need to be taken before anything ever made it to court.

Have you exhausted all levels of appeal with your insurance company?  (Your state's Department of Insurance will not even look at a complaint from you until you've exhausted your internal appeals with the insurance company.)

If you've went through the appeals process and not gotten a satisfactory answer, then you should file a complaint with your state's Department of Insurance.  They will review the information, get documentation from the insurer, and determine whether or not they think your claim should be paid (based on the details of your policy and the services you had done).

If the Department of Insurance states that they think your claim should be paid and your insurer still refuses to pay, that's when you might consider going to court.

So...its hard to say whether you should go to court, based on the information you've provided.