Although heavily regulated, Private Health Ins. is a contract, especially if it is an Obama policy that provides additional protection but still a private contract, and therefore contract law does apply.

-Private Health Ins Co (gov’t entitlements are a little different) has an administrative process that needs to be followed before you can go into court and sue them in court.

-There are reasons why the claim is denied, such as the referring physician did not document the medical records, and additional documentation needs to be sent to the insurance.

-The insurance company may deny due to medical necessity, and once the medical records are provided then, they will provide coverage

-The explanation of benefits will state the basis for denial. Provide additional documents and go through the appeals process within a specific period.

-If the appeal/administrative process with the insurance company is denied at the end of the day, you may file suit against the insurance company.