Spine surgery patient prevails in payment denial suit against insurer
By Admin | May 05, 2021
A North Carolina woman's health plan was ordered to cover her spine surgery after a district court found the insurer failed to provide complete records to the reviewers who recommended coverage denial.
Dorothy Garner filed a lawsuit in the U.S. District Court for the Middle District of North Carolina against Central States, Southeast and Southwest Areas Health Plan and Welfare Fund Active Plan to cover the costs of her 2019 spine surgery. Central States refused to pay the bill after two reviewers deemed the surgery medically unnecessary.
Central States sent the initial reviewer, a board-certified general surgeon, some but not all of Ms. Garner's medical records. The reviewer concluded surgery wasn't medically necessary because...(More)
For more info please read, Spine surgery patient prevails in payment denial suit against insurer, by Becker's SpineReview