Health Insurance Claim Denials in Michigan

Health insurance is vital, but insurers often deny coverage when it’s needed most. If your claim has been denied, you are not alone. JuneLaw takes on these cases because it’s the right thing to do, even when other attorneys won’t.

If you are being denied your rightful health insurance claim, you are not alone. It can be devastating to hear that the medical treatment you or a loved one needs is not going to be covered. If this happens, reach out to the JuneLaw team right away.

Unfortunately, even though the impact can be life or death for some people, the insurance company can only be sued for the amount of the benefits, and Michigan insurance companies can’t be sued for acting in bad faith while they deny your coverage.

There are not many lawyers who will handle these types of insurance cases because of the complexity of the cases, and the relatively low financial return.  

At JuneLaw, we are willing to take on the fight to get you your rightful benefits.

Here are some scenarios we have seen. It is a small cross section of cases, and we understand that every single case, just like every individual, is unique.

Denied pharmaceuticals can have dire consequences for the person needing care. For example, people with very bad conditions often need highly specialized drugs, and they need them at specific doses with specific frequencies. These drugs are often extremely expensive. However, the insurance company may say they are not medically necessary, or they come up with some argument about a preexisting condition (even though they are supposedly prohibited by law from doing this). Or they may decide to pay for only part of the medication. Sadly, the insurance company may make these decisions based on the opinion of one of their own doctors, who never even examined you. 

Another situation we encounter is denial of care when seeking residential treatment for substance abuse or mental health issues. Insurance companies are required to cover residential care for mental health and addiction, just like other medical treatments. However, they often deny coverage, claiming treatment is “out of network” or “not medically necessary.” 

For example, when people are trying to recover from some kind of addiction, they almost certainly need to do it in a residential care facility because the addiction is so powerful that outpatient treatment will not work. But the insurance company may decide you only get three days of in-patient care. The result is often an unsuccessful recovery. 

Beware of reversals on insurance coverage. For example, people sometimes find that after having been pre-approved for a surgery, they find out that their insurance company has denied your claim while you are recovering from that surgery. 

Don’t let insurance issues prevent you from getting the care you need.

Health insurance claims can be impacted to a great degree by the Employee Retirement Income Security Act of 1974, commonly known as ERISA (see ERISA: How it Impacts Your Claim). When your claim is denied and you are employed by a private industry (ie, not by the government or a church), sometimes the best way to seek justice is through ERISA.

This means you will receive the best help by an attorney knowledgeable about both insurance claims and ERISA. This is not common. If you find yourself in this situation, you are in excellent hands with the team at JuneLaw, where attorney Bob June and his staff have deep expertise and experience in both insurance claims and ERISA.

At JuneLaw, we have extensive experience working with a wide range of insurance companies. With experience across this broad spectrum, we are well-equipped to handle claims with various insurance providers.

The insurance companies we have worked with include (but are not limited to):

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