Lawsuit: Insurance Plan Refuses to Pay for Pre-Approved Acupuncture Treatments
by Erin Shaak
Last Updated on May 8, 2018
K.B. v. Neca-Ibew Welfare Trust Fund
Filed: February 15, 2018 ◆§ 0:18cv60352
NECA-IBEW Welfare Trust Fund is facing claims that the insurance plan unlawfully denied coverage of medically necessary acupuncture treatments that were 'contracted for and promised' to policyholders.
NECA-IBEW Welfare Trust Fund is facing claims that the insurance plan unlawfully denied coverage of medically necessary acupuncture treatments that were “contracted for and promised” to policyholders. According to the suit, the defendant pre-approved the plaintiff’s coverage of acupuncture to treat chronic pain but refused to pay the $12,600.00 bill because the plaintiff was also being treated at a substance abuse facility and was not enrolled in “formal physical therapy.” From the complaint:
“Defendant has taken the odd and untenable position that otherwise covered acupuncture benefits are not covered if the patient is concurrently undergoing behavioral health treatment. Defendant further claims that acupuncture is only appropriate and medically necessary when administered in conjunction with a formal physical therapy program. However, nowhere in Defendant’s advertisements, Policy, or Summary Plan Description of acupuncture benefits, does Defendant disclose that acupuncture is not covered under these circumstances.”
The case argues that acupuncture is “generally accepted as medically necessary and appropriate for the treatment of chronic pain” but that the defendant denied coverage based on “non-existent and made up exclusions.”
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