Insurance Company’s Decision On Emergency Medical Flight Raises Eyebrows

Posted December 25, 2016

One particular legal doctrine known as “officious intermeddler” appears to be making an appearance on a regular basis when it comes to healthcare and associated claims. An officious intermeddler is one who interjects themselves into a situation without first obtaining permission and then seeks compensation for doing so. In the context of healthcare, this can be a serious issue, especially if your insurance company eventually decides that that service you were provided wasn’t necessary, so you’ll be paying out of pocket for it.

Many of us have encountered circumstances like these, especially if an ambulance was called for us without our permission or knowledge, only to find a bill in the mail for providing that “service” that may or may not even have been used. For one family, the consequences of a dire, life or death medical need ended up doing far worse damage, bringing to light the bad faith that health insurance companies often exhibit in denying claims.

Emergency Medical Flight to Save Child

According to the news story, one pregnant mother was rushed to a hospital nearby, which was unequipped to care for a premature baby after going into early delivery. Once the doctors at that hospital stabilized the mother, they ordered her to be airlifted to a different hospital that was equipped to care for the baby.

As a result, the family eventually found themselves in the position of being denied a home loan several years later due to a problem with their credit report; specifically, a finding that they had been turned over to a collections agency due to supposedly owing more than $50,000 for the helicopter ride. They had never even received a bill in the mail.

Health Insurance Won’t Pay

When the family contacted their health insurance company (Anthem Blue Cross Blue Shield), they were informed that the company was not paying the bill because they determined that it wasn’t “medically necessary” for the woman to be airlifted.

This type of determination is absolutely legally challengeable, especially since doctors at the first hospital—medical experts—were the ones who determined that it was medically necessary for her to be airlifted. In order to challenge a claim denial by a health insurance company, obtaining as much information as possible—including key documents—is the first step in assembling what you need. Those documents include the denial letter, a copy of your Evidence of Coverage details, and the company’s guidelines regarding what it considers to be ‘medically necessary.’ Some of these documents should be available online.

The next step is consulting an experienced attorney who regularly deals with challenging insurance claim denials. In addition, exhausting any intern appeals process that the company provides for first is also necessary prior to bringing a legal claim. Your attorney can work with you on this step.

Health Insurance Claim Attorneys

If you’ve been taken advantage of by your health insurance company, we can help. Our attorneys focus on bad faith insurance claims and have successfully helped many clients due over breach of contract and additional damages. Contact us today for a free consultation and we can discuss your rights, (405) 272-0303.