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Experimental Treatment Denials

Bad Faith Denial of Your Insurance Claim?  Call 213-489-1600

Insurance companies will look for any reason to protect their bottom line by avoiding a payout.  One of the most common reasons cited for denial of coverage is that a form of treatment is “experimental,” meaning that the medical community does not yet accept it.  Experimental treatments are not covered by many policies, even when those treatments have proven to be the best or only solution to a medical problem.  Moreover, insurers may try to claim that a treatment is experimental even when it has been accepted by mainstream medical society.  Patients whose claims are wrongfully denied can appeal those denials and, if bad faith is proven, may even receive additional compensation.

If you have a medical issue and your health insurance provider denies coverage for treatment because the procedure is deemed experimental, the California insurance bad faith denial attorneys at Gianelli & Morris are ready to help you plead your case.  We will go toe-to-toe with the biggest insurance companies to ensure that they are not frivolously or maliciously denying claims that should be covered, simply to save themselves money.  We hold insurers to task, forcing them to investigate every claim fully and explain any denial.  We will ensure that your health concerns are not dismissed lightly and fight to see that you get the coverage you deserve for the treatment you need.

What is an Experimental Treatment Denial?

Insurers protect their bottom lines by limiting coverage to certain treatments.  One aspect of this policy is requiring scientific proof that a treatment actually does what it purports to do.  Insurers argue that if they paid for experimental treatment, they would be subsidizing medical research and paying for unproven treatments.  Unfortunately, insurers often end up taking a blanket approach when it comes to certain types of treatments, denying entire areas of treatment even where there is evidentiary support for effectiveness in certain situations.

It is important to understand what “experimental” and “investigational” treatment means in this context.  For insurance purposes, these terms mean any treatment, therapy, drug/drug usage, or procedure that has not been approved by the FDA and has not been recognized by generally-accepted medical standards.  The definition also includes treatments that are considered unsafe or ineffective with regard to certain medical conditions, illnesses, or injuries.

If a procedure is approved by the FDA, the insurance company has no business denying the treatment as experimental.  Such a denial would provide strong grounds for an appeal.  Additionally, lack of FDA approval might not be a definitive cause for denial if the medical community has come to agreement on certain treatments, drugs, or procedures being used to treat certain ailments.  The definition of experimental can be nebulous and contested; the insurance denial lawyers at Gianelli & Morris have years of experience helping clients work against the overbroad use of the term experimental.  We will work to find the evidence and the experts to support acceptance of your treatment in the medical community and strongly contest improper denials.  If you need a treatment to get better, we will fight for your right to the payments you are owed.

Get Help From Our Los Angeles Insurance Bad Faith Denial Attorneys

Insurance companies regularly make erroneous denials based on allegations that treatments are experimental.  Do not let your health insurance company get away with denying the coverage you deserve for the treatments that you need.  If you were improperly denied coverage, you have rights.  Proving that an insurance company acted in bad faith in denying your claims can be a drawn-out and difficult process.  The insurance bad faith lawyers at Gianelli & Morris are ready and able to pursue your claim, negotiate with your insurance company, and fight for your rights.  We have spent years securing coverage for our clients in the face of bad faith denials by the nation’s largest insurers, and we are prepared to take your insurance company head-on.

If you are not receiving money that you are rightfully owed, or if an insurer is preemptively denying you coverage for the treatment you need, do not delay.  Call the insurance bad faith attorneys at Gianelli & Morris for a free consultation at 213-489-1600.

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