Things You Can Do to Help Us Help You Get Your Insurance to Cover Eating Disorder Treatment
A Kantor & Kantor, we are dedicated to helping you receive the insurance benefits to which you are entitled. We spend every working day battling insurance companies so that you can have access to the treatment you so desperately and rightfully deserve. In order for us to help you obtain coverage for the treatment of your eating disorder, there a few things that we want you to know about - things that you can do, to help us best help you:
1) Request a copy of your insurance policy before going into treatment. Without a copy of your policy, you don’t know what your coverage is. We cannot assist you in determining what your benefits are until we read your policy. You can easily request a copy of your policy from your employer, or directly from your insurance company. They are required by law to give you a complete copy upon your request.
(The Nitty Gritty): Remember to ask for a full and complete copy of your policy and do not accept a “summary of benefits.” You should receive a booklet that is 80-100 (or more) pages in length. Also, do not let your insurance company or employer tell you that they cannot give you a copy. You must be furnished a copy upon request. Familiarize yourself with your policy, but also understand that sometimes even our attorneys find policies confusing and complicated. Do not be discouraged if you are unclear about what your benefits are after reading your policy. If you need help determining what coverage you have, we are happy to review your policy without any cost to you. DO NOT underestimate your benefits or let your insurance company tell you over the phone, “You don’t have residential treatment.” Why? Because sometimes, even if it seems like you don’t have coverage, you might have access to benefits because of the Patient Protection and Affordable Care Act,The Paul Wellstone and Pete Domenici Mental Health Equity and Addiction Act, or your state's mental health parity act.
2) STAY IN TREATMENT, EVEN IF INSURANCE DENIES OR TELLS YOU THEY WILL NOT PAY FOR TREATMENT. Not everyone knows or remembers this piece – but it is incredibly important. It is important not only for your health and recovery, but also for your chances to challenge an adverse decision or insurance denial. Even after receiving an insurance denial, YOU MUST STAY IN TREATMENT IN ORDER FOR US TO PURSUE LEGAL ACTION. We want you to know that this is not “our rule.” Why do we need you to stay in treatment? Because of ERISA, the Employee Retirement Income Security Act. ERISA governs employer provided insurance policies. ERISA dictates that we cannot pursue legal action for you, without first being able to prove that you lost benefits because insurance did not pay your benefits or cover treatment. And of course, the only way you will have unpaid benefits is if you stay in treatment… and pay out of pocket.
(The Nitty Gritty): Trust us, we know that not everyone can afford to pay out of pocket for treatment. If we could modify ERISA, and make it so that we could help you without asking you to pay for treatment, we would. Remember, even if you can’t afford to pay out of pocket, do not give up! We encourage you to talk with the treatment center and ask them if they will allow you to stay in treatment while we work on your case. Perhaps you can work out a payment plan while you pursue legal action. We always recommend that our clients follow the advice and recommendations of their treatment team, not their insurance company. Do not let the insurance company dictate your recovery! You deserve to have access to the benefits that will help you or your loved one heal and we want to help you. But in order for that to happen, we ask that you help us help you by staying in treatment.
3) Know that an insurance denial is not the final word. An insurance denial can be incredibly frustrating, stressful, and intimidating. The appeal process is complicated, but we can help. After a written denial, contact Kantor & Kantor for support. Let our expert attorneys work with your insurance company and treatment facility after a denial. You have enough to worry about while you or your loved one is sick and in treatment, so let us work to gain reimbursement of the benefits available under your policy.
(The Nitty Gritty): If your insurance denies coverage for treatment, we can only help you recover benefits if you have an insurance denial in writing (and have STAYED in treatment to prove a loss of benefits.) Without a denial, we cannot help you. We need to be able to prove what was denied and when.
We hope this information gives a better understanding of how you can help us help you. Please know that we really wish we could help every single person who contacts our office. We firmly believe that everyone deserves access to life-saving treatment. However, sometimes we are not able to assist or sometimes we are simply not the best fit for your legal needs. We never turn away cases because we don’t want to help. If we do not feel we are the best firm to handle your case, we will do our best to refer you to an expert who can assist you.
If you have been denied insurance coverage for the treatment of your eating disorder or mental illness, or if you have any questions about how we might be able to help, please contact us for a no-cost consultation.
(800) 446-7529
www.kantorlaw.net
