Miami Health Insurance Lawyer
More than ever, Floridians suffering from injuries and illness — whether chronic or acute in nature — are seeking out alternative medical treatments (i.e., homeopathic remedies, massage therapy, traditional medicine, etc.) to resolve their health problems in a way that they feel comfortable with. This trend is unsurprising. In recent years, many have expressed their anxieties about the ubiquity of heavy pharmaceutical and surgical treatment in situations that might be more gently resolved through the use of alternative medicine.
If you’ve received alternative medical care — in conjunction with standard medical treatment or exclusive of such treatment — then you may find that your health insurer denies your claim for benefits on the basis that your care is not “covered” or otherwise fits an exclusion in the insurance policy.
It’s important to understand that a denial of benefits does not signal the end of your insurance claim. You are entitled to challenge the decision of your insurer, and in fact, depending on the wording of the policy, the denial may have been wrongful.
Let’s take a closer look.
Healthcare Insurance Coverage is Generally Limited to Medically Necessary Treatment
Most healthcare insurance coverage extends only to “medically necessary” treatment. Every plan defines “medically necessary” differently. One plan may explicitly list out treatments that are medically necessary (given certain diagnoses), while others may give a more general definition that references functional impairment. For example, an insurance plan may deem treatment as “medically necessary” if it is cheap, efficacious, and safe compared to the alternatives and is reasonably likely to resolve the impairment at issue.
Generally, alternative medicine is not considered “medically necessary” according to the policy definitions. Some policies only cover a limited subset of alternative treatments that have been deemed safe and effective within the larger corpus of medical science/literature. For example, acupuncture is often covered as there is a great deal of evidence linking such treatment to positive results for patients with neuromuscular issues.
If your plan does cover certain alternative medical treatments, it’s important to consider whether there are any further limitations on such coverage. Some policies specifically restrict the number of visits and even the comprehensiveness of such treatment. We encourage you to speak to a qualified attorney at Ver Ploeg & Marino, P.A. who can evaluate your insurance contract and determine the limits of coverage more accurately.
Contact an Experienced Miami Health Insurance Lawyer for Comprehensive Assistance
Ver Ploeg & Marino, P.A. is a Miami-based insurance litigation firm, and we have decades of experience representing the interests of policyholders in disputes with healthcare insurance companies. We are fundamentally results-focused. Over the years, we have secured multimillion dollar verdicts and settlements on behalf of our clients, in the healthcare insurance context and otherwise.
We understand that our clients may be feeling overwhelmed, even distraught, at having their legitimate health insurance claim denied. It is often puzzling to first-time insurance litigants when they discover that insurers are not actually their allies, and in fact, that health insurers are working against them to minimize payouts.Share