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Focusing on personal injury, civil litigation, whistleblower claims and workers' compensation law, Siesky Law Firm strives to provide excellent legal services while remaining client and community centered. The Evansville-based trio of top attorneys - including Lane Siesky, Daniel Gearhart and Douglas Briody - boasts years of invaluable experience inside and outside the courtroom. Highly-respected with an impeccable track record, the firm's aggressive representation of its clients continues to benefit the community in myriad ways.

Q: I was experiencing belly pain for a number of months and my doctor wanted to do a CT scan but the insurance company refused to pay for it. Eventually, it was determined that my gall bladder should be removed; however, this procedure failed to alleviate the pain. As a result, a CT scan was finally ordered - more than a year after the initial request - which showed that the problem resided in my colon. Post-surgery I'm recovering, but I'm seriously considering suing the insurance company for refusing the initial CT scan request which led to the unnecessary removal of my gall bladder and caused me to suffer an entire year of intense pain that could have been avoided with the proper diagnosis. Should I move forward with the suit?

A: When your doctor recommends a diagnostic medical procedure, it is important to make sure the procedure is timely approved by your health insurance. Normally, your doctor’s office will work with the health insurance company to make sure the procedure is approved. In this situation, if your health insurance refused to approve a CT scan recommended by your doctor because of belly pain, I would want to know why health insurance would not approve the scan.

In other words, there could be good reasons the health insurance did not approve the scan. For instance, was there adequate justification for the scan documented in your doctor’s chart? Did your doctor follow the proper procedure for requesting approval? Did the health insurance company request additional information and the doctor failed to provide it?

If, however, the doctor’s office did everything necessary to obtain approval and the health insurance company simply failed to approve the scan, the question for the health insurance is why? It seems unlikely to me that a timely and well-documented request for a CT scan would be denied given belly pain being present. Nevertheless, if, in fact, the health insurance’s denial was unjustified, then you may need to follow an appeal process with the health insurance company. These appeals can be time-sensitive and complicated. Again, your doctor’s office normally will assist you with this appeal process.

If you do need to take legal action, then you will want to consult a knowledgeable attorney to help you evaluate and potentially pursue a claim.

Disclaimer: The above information provided by Siesky Law Firm, PC, is not legal advice and should not be taken as legal advice. Application of the law is highly fact sensitive and readers should consult with an attorney on legal matters.