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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Employment Law
Satisfied Customers: 110592
Experience:  20+ Years of Employment Law Experience
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Denied disability months waiting drugs to be approved by

Customer Question

Denied disability for 2 months waiting for specialty drugs to be approved by insurance; finally approved in Jan. 2016. No pay, no insurance. Now the insurance company has stopped my refills after approving until May, 2016.
Is there any way to help me. These drugs are thousands of dollars & I just got my 1st paycheck in March since Oct. 2015. How can they approve then just stop?
Submitted: 7 months ago.
Category: Employment Law
Expert:  Law Educator, Esq. replied 7 months ago.
Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.
You need to start by filing a written appeal to the insurance company to reinstate your benefit and make the payments. That is the second level appeal. If they deny you, then you can make a third level appeal and demand an independent review, but for that you would have to engage a local attorney.
Your option is you can sue for breach of contract and take the insurer to court and get the court to force them to pay. They cannot just stop the payment for an approved medication.

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