We handle ERISA § 502 claims against group health insurance policies for benefits payable under the plan.  Employer provided group health insurance policies offered through your employer are usually employee benefit plans covered by ERISA.  The administrator may deny coverage for a costly surgery and after-surgical treatment because it claims the treatment falls into an exclusion in the plan.  In other instances, health insurers provide an approval for the treatment or procedure, only later to deny paying for the cost, leaving you with doctor and hospital expenses in the upper five figures, six figures, or in some cases even in the millions.  Often, the surviving spouse of a participant with a morbid condition, or co-morbidities, is left with bills which the insurer rightfully should have covered.  

When your insurer refuses to pay for a treatment or surgery you already underwent, it is critical to involve an ERISA lawyer immediately.  Ignoring the problem, or letting the hospital fight with the plan, will only result in the hospital suing you for payment.  And if you wait long enough, you can lose your right to appeal the claim with the insurer.

While we cannot undertake engagements every time health insurance plan administrators refuse to properly pay benefits, in some instances the denial may justify involving us for assistance.  These claims often present unique issues for executives, managers, and other professionals, whose families depend upon them for financial support and need to devote their attention to their business, rather than dealing with an insurer.  We help clients obtain reimbursement for surgeries, procedures and treatments that should be covered under the health plan.