Sorry, we won’t cover that…or that… or that…

Can you think of anyone actually wanting to have back surgery? Most of us would only agree to it if it were absolutely needed – and recommended by our doctor. That’s exactly what happened to Kim Kutcher, a nurse from California whose back pain got so bad that she couldn’t do her job or live a normal life – even with pain pills.

According to a recent article in the Orange County Register, Kutcher and her doctors decided that her pain was too much and that back surgery was needed. However, Kutcher’s insurance company, Blue Cross, denied her claim – something that she still doesn’t understand because other insurance companies such as Cigna and Kaiser Permanente and others would have covered it.

Although she decided to have the surgery anyway and pay for it herself, the $63,000 hospital bill has been an enormous burden on her family as her husband is the only one currently bringing home a paycheck. So, what can you do when your insurance company denies a medical procedure when other insurers cover it?

Get the details

It’s important to get the details on why a medical procedure isn’t covered. Many times, insurance companies will simply tell you that it’s not covered in the hopes that you won’t read the policy itself. Ask the company to explain exactly where that policy language is located and speak with an experienced attorney to determine if that language is valid. Unfortunately, some insurance policies contain vague language that can always be interpreted by insurance companies as being a valid denial – but actually isn’t.

Blue Cross seems to be in the news continually for its bad faith insurance practices, which is even more reason to speak with a lawyer who understands how insurance companies operate when faced with a situation such as Kutcher’s. If your insurance company has denied your valid claim and you would like to speak with a lawyer about your situation, please click here. Consultations are free, without obligation and are strictly confidential.