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Infolawyer, Lawyer
Category: Consumer Protection Law
Satisfied Customers: 6606
Experience:  Licensed attorney helping individuals and businesses.
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On April 2 2016 I went to Summerlin Hospital Emergency Room.

Customer Question

On April 2 2016 I went to Summerlin Hospital Emergency Room. I had severe diarrhea for 8 days prior. I am currently on Medicare and Humana Hmo is my provider. I have seen a gastroenterologist for the last 3 months, but my appointments were constantly being cancelled, and rescheduled. The week prior to my HR visit when I was having symptoms I tried to schedule an an appointment with my gastrointestinal Doctor, I was told there were no appointments available. On Saturday April 2 my symptoms I was extremely weak, and the over the counter medications that I was taking only slowed the symptoms down for a short while. I had been prescribed Viberzi, and XIFAXAN by my Gastrointestinal Doctor, but the insurance company refused to pay, and the costs were 1115, and 1500 . I have been sent a letter by my insurance company stating that my trip to the Emergency Room does not meet the definition of an emergency, and they are refusing to pay for the medications, and tests that were performed. What if any recourse do I have?
Submitted: 7 months ago.
Category: Consumer Protection Law
Expert:  Infolawyer replied 7 months ago.
are you asking if insurer is liable? have you appealed the decision or considered other ways to get insurer to review it again? would you like those options?