Your insurance company may not always pay as promised

Summary

According to Consumer Reports on Health, if the insurance company can show that whatever you had done was not medically necessary they can withhold the promised payment.

Story Published: Sep 7, 2007 at 11:22 PM PST

Story Updated: Sep 7, 2007 at 11:23 PM PST

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Q: If an insurance company approves a medical procedure or treatment, can it withhold payment after you've had the procedure or treatment done?

A: Believe it or not, the answer is yes. According to Consumer Reports on Health, if the insurance company can show that whatever you had done was not medically necessary they can withhold the promised payment. This can be based on information the insurance company uncovers after the procedure was performed.

And just what does medically necessary mean?

"That's an iffy sort of qualification that can usually be verified by your physician," says Dr. Marvin Lipman, chief medical adviser to Consumers Union.

If the insurance company still refuses to pay, you have the right to dispute that decision -- whether the reason give is medical necessity or something else. Your contract with the insurer will tell you how to do that, how long you have to file your claim and what you need to provide.

For More Information:

Washington State Office of the Insurance Commissioner

How to avoid a health insurance claim denial - and what to do when you can't

Fight for Your Rights: Health Insurance Claims

Tips to effectively battle your insurance company