Imagine you’ve just been in a car crash. You’ve had x-rays, MRIs, CAT scans and everything else imaginable to assess the damage.
Finally, your doctor comes in and tells you how serious your injuries are and what the options are for your recovery. Although you’re confused, frightened, and in pain, you listen to all of the options and the both of you decide on the best course of action for your physical and psychological treatment.
Throughout this ordeal, you didn’t reject the expensive tests or worry about the cost of the viable treatments because you believed your insurance should cover it. But what happens if the insurance executives decide not to pay, claiming they don’t believe you really need the treatment? What can you do to be sure the insurance that you pay for will cover the care you need?
When Your Insurance Company Won't Accept Your Claim
Depending on your injury and the treatment required, your insurance company may not accept your claim. If it determines that the care you’re receiving is experimental or falls under their broad definition of alternative medicine, it will reject your claim. You’ll then be forced either to pay for the treatment out of your own pocket or forego the care altogether.
Was the Care You Received Experimental?
Common criteria that insurance companies use to determine if a treatment is experimental (and therefore not reimbursed) are:
- Are there other, less expensive, treatments available?
- Is it FDA approved?
- Is it necessary? (Note: psychological treatment can be harder to justify)
- Is it a part of a study or ongoing research?
Injured in a Car Accident? Let Us Help
If you’ve been in a car accident and your insurance company refuses to approve your claim based on the notion that your treatment is “experimental,” contact the lawyers at Shevlin Smith for a free consultation. We’ll investigate your claim to make sure you get the necessary treatment you require. Call us today at 703.591.0067.