Legal Question in Insurance Law in Florida

Denied medical insurance benefit

My insurance company will not pay for an oral splint to treat TMJ, but will pay for costly and potentially risky surgery to reposition the ligaments and tendons in my face. My doctor's office thought the approval for ''3 visits and treatment'' included the splint. Now my doctor's office wants to charge me half of the total cost. First, I feel my insurer is not working in the best interest of the patient by pushing surgery and not paying for the splint. Second, since my doctor's office is responsible for getting approvals, shouldn't they be liable for the cost?


Asked on 3/21/02, 3:10 pm

1 Answer from Attorneys
Joel Cohen Joel M. Cohen,P.A.

Re: Denied medical insurance benefit

Your ins co should have an appeals procedure; make lots of noise...demand to talk with claims supervisor, etc.

I am appalled that you would want your doctor to pick up the cost of your treatment.If the ins co fails to pay; you pay. The Dr.is not obliged to treat you.

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Answered on 3/21/02, 9:07 pm


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