What if insurance denied hubby for tumor on his leg?

Question

My husband had this giant growth (bigger than basketball) on his inner thigh. He wanted to get it removed, but the insurance denied him (they felt it was cosmetic!!!)

Well, a few months later, this growth got super infected and it caused his entire system to get infected ("septic"), and he ended up in the intensive care unit (close to death) for 10 days. In addition to this health insurance, he also was a military vet. The military hospital had to cover the entire cost.

If he had been approved, this surgery would of been much less complicated and he would not have suffered so much.

What kind of attorney or law-firm covers coverage-denial?

I am hoping to find one that is "no win- no pay" because after all that happened, my husband lost a month or more of pay wages.

We don't want to become millionaires -- we just want lost wages for both of us, at least.

Answer 1

A good lawyer will salivate over this case.  Yes, you have lost wages, but you also have pain and suffering, which usually amounts to twice the cost of the medical work (not what you paid, but the cost to the VA).

They will take the work for free and do not let them ask for more than 33% of the settlement, and believe me, there will be a settlement.

Your insurance company stiffed you, and they will not want a trial.

Answer 2

honestly, in your case.....I doubt if  a lawyer could do anything.  Had your husband died as a result of the denial, then definitely.  All you can do at this point is file an appeal.  And since the money didn't come directly from you, that won't do you much good either.  

Answer 3

Did you go through all the levels of appeal when your husband initially wanted the growth removed?  Did your husband's doctor send in medical records and/or photographs of the growth?

If your husband's physician didn't send in all of the medical records and/or you guys didn't use all levels of appeal available to you, you might have a hard time with this case.  The insurance company can only make their pre-authorization based on the information available to them at the time.  And if you didn't formally appeal the initial decision, that might harm your chances in court too...when a pre-authorization for a service is denied as "cosmetic," you always have levels of appeal where you can send in medical records to prove that it was medically necessary.

Gather all the relevant information (including copies of the medical records that were sent on your husband's behalf, appeal letters that you sent, copies of the specific reasons for denial from the insurance company, etc.) and provide it to the attorney - they will tell you whether or not you have a case.  If you need assistance finding a local attorney, contact your local Bar Association.  They can give you names of attorneys in your area who might handle those sorts of cases.

But definitely document exactly what information you/your husband and his doctor provided to the insurance company...including whether anyone contacted the insurer between the time of the initial denial and when he got infected.  The fact that there was a few month lapse between the denial and his infection makes me wonder whether or not you'd have a case...the insurer could make the argument that if there was a change in your husband's medical condition in that time, someone should have provided the additional info so that they could authorize the surgery.  (If this was actually done, then it would strengthen your chances, of course.)

Answer 4

call five different attorney's from the yellow pages who specialize in medical and see what the different answers are.  They usually have a no charge consulting fee.  Make sure you shop a bit.  I'm glad he is alive!

Answer 5

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Answer 6

Any general attorney could handle this.  They'll look at the case, see how much money you lost, see what your damages could be, see if your prior doctor was recommending the procedure for health reasons, and figure out if they have a chance of winning.  If they do, they'll take it.

If your doctor didn't deem it medically necessary, you'll lose a case against the insurance company.  You could try suing the doctor, but again, it will depend on what caused the infection, and if your doctor made a bad judgement call.

I'd say, your case is stronger against your doctor, than against the insurance company.