Health Insurer Ordered to Pay $25.5 Million For Wrongful Cancer Treatment Denial

In a timely followup to last week's discussion of how to fight health insurance denials, this week an Oklahoma jury ordered health insurer Aetna to pay $25.5 million for denying coverage for insured's Orrana Cunningham's cancer treatment bills.   Aetna had denied coverage for Orrana's treatment in 2014 on the basis it was "experimental;" after …

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How to Fight A Health Insurance Denial

Many Americans increasingly find themselves dealing with huge medical bills after medical procedures their health insurers should have covered.  All too often, the insurance company says "it's not our problem, talk to the hospital;" the hospital says "it's not our problem, talk to your insurer;" and the insured is left holding the bag, often at …

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Washington State Insurance Commissioner Fines United Healthcare for Denying Women’s Health Claims

On September 13, 2018, Washington's Insurance Commissioner entered into a Consent Order with United Healthcare regarding violations of Washington insurance law governing women's health claims.  United Healthcare is a health care service contractor that sells individual and family health insurance coverage. The Insurance Commissioner's investigation was prompted by a consumer complaint that United Healthcare improperly …

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Update Your Insurance Coverage – Cautionary Tales

Many people purchase insurance and forget about it until there's a loss.  It's easy to buy a policy online and set up automatic payments.  Then, you get an email from the insurer once every six months that your policy will renew automatically, and let it occur without giving it a second thought.  Setting your insurance …

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ERISA Plan Administrator Cannot Unilaterally Ignore Treating Physicians, Appeals Court Confirms

A recent appeals court ruling emphasizes that ERISA plan administrators cannot ignore the opinions of a claimant's treating physicians absent tangible evidence those opinions are wrong.  In Hennen v. Metropolitan Life Insurance Company, the appellate court ruled the plan administrator acted arbitrarily in discounting the opinions of the claimant's treating physicians and remanded the claim …

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