Insurance companies like to act as though medical treatments are more of an optional choice instead of the absolute necessity that they are. They clearly demonstrate this attitude by denying claims for patients who desperately need care. This not only puts a tremendous financial burden on people in Washington, but it also jeopardizes their health and financial situations.
One out-of-state family is unfortunately all too familiar with this. The family’s 6-year-old son was born with Down syndrome and requires specialized behavioral therapy in the form of advanced behavioral analysis, or ABA. The goal of this therapy is to help him develop the necessary skills for him to one day be more independent.
Although the therapy has been going very well for the young boy, things have been a lot harder for his parents. They chose to go with a high tier insurance policy that promised coverage for ABA therapy, but their insurer refuses to pay approximately $20,000 in medical bills. The insurance company agrees that the policy covers ABA therapy and even that the facility is in network. However, the specialist in charge of the boy’s care was still new to the facility when he started, and at that point the insurance company had not credentialed her just yet. She is now in network, but the company still will not pay.
No one should have to jump through hoops or carefully scan through every last word of a policy to avoid possible loopholes that the insurance companies can use against them. But the reality is that Washington patients have to do this kind of stuff every day. Even though denying claims might be a favorite pastime of the insurance companies and something they even excel at, getting the right help from an experienced attorney can help when fighting back.