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P. Simmons
P. Simmons, Attorney
Category: Estate Law
Satisfied Customers: 26329
Experience:  12+ yrs. of experience including estate law.
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I found my daughter without pulse and breathing, called 911,

Resolved Question:

I found my daughter without pulse and breathing, called 911, and they got a pulse took her to the nearest hospital where she was on life support for 5 days. On the 6th day she woke up and was release medically stable after 10 days in the hospital.
Her insurance will not pay for anything because it was out of network "we should have gotten prior authorization. In the meantime my daughter passed away anyway leaving a house where the mortgage is about the same as the value of the home. She has no will.
She left a 401k without beneficiaries. How can this problem be resolved, especially with the approximately 180,000.00 medical bill.
Submitted: 1 year ago.
Category: Estate Law
Expert:  P. Simmons replied 1 year ago.
Thanks for the chance to help. I am an attorney with over 12 years experience. Hopefully I can help you with your legal question.

I am sorry for this dilemma

Consider having an attorney engage with the insurance provider. The medical provider has a right to demand payment. So the issue is if the insurance provider is required to pay or not.

Now...insurance is a contract, so the provisions of the insurance policy will dictate.

But it is also heavily regulated by the state.

In no case will there be a requirement for "prior authorization" for "emergency stabilizing care"

There may be a requirement to transfer after stabilization...so it may be that she (her estate) is on the hook or some of the bill. But what you describe? If she was on life support for 5 days, I suspect that the insurance company is on the hook for a good bit of that bill

It makes sense why they would deny...she has passed, I suspect they figure it will not be fought. That is not ethical...and likely not legal...but I can understand why some insurance companies would take that action.

I would have a local attorney file a "demand letter" with the insurance provider, demanding they pay this bill and letting them know if they refuse you will sue. This may well get them to come to the table and negotiate a settlement. If you can not reach an acceptable settlement, I would sue them on behalf of the estate.

HOWEVER, before you do that? Contact your state's insurance commission. Your states insurance commission will have a complaint process where you can file a complaint. Insurance companies are not supposed to do this (deny obviously valid claims)...so I would start with a complaint against the company. Then I would follow with a demand letter (most attorneys will draft and send one for a nominal fee). It may be this is enough to get the insurance provider to act reasonably.

But if you are forced to sue, it sounds like you have a good case


Please let me know if you have more questions...happy to assist if I can
P. Simmons, Attorney
Category: Estate Law
Satisfied Customers: 26329
Experience: 12+ yrs. of experience including estate law.
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