Legal Question in Health Care Law in Louisiana
claim
My health care provider plan clearly states that I access plan's in-network facilities for health care and that I inform health benefits coordinator within a 2 day period if I'm admitted into a non-network facility. However, I had a medical emergency that needed to be addressed. So I went to the nearest hospital to see about my pain. Unfortunately, I did not read the fine print and was unaware of the 2 day notification window. Is there a case for me? Am I stuck with this $22,700 bill for the rest of my life
1 Answer from Attorneys
Re: claim
Usually, the plan has a provision that provides that, in emergency situations, the notice that need be given need only be "reasonable," if at all. The ultimate answer to your question depends on specific language of the plan and the reason for the denial of benefits. There are probably appeals procedures in the plan that you are going to have to follow as well before you can challenge the decision in court (if you ultimately have to do that). You should really discuss this with an attorney, particularly before you appeal, as your rights in court are dependent on the information you submit in your internal appeal.
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