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Carl's complaint:
October 10, 2014

Insurance Company: Anthem
Coverage Type: Health Insurance

  • Claim Handling - Denial of Claim

I\\\'m writing to you to ask for help and advice as to what to do next. I have been dealing with chronic back pain for the last 8 years. My Neurosurgeon Michael Boland (The Best in St. Louis) says I need spinal fusion surgery. My wife\\\'s insurance Anthem BlueCross says it is not a medical necessity. Our health insurance switched to a high risk plan. My wife pays $67 a week for this and our deductible is $4000. Now that we have reached our deductible and paid about $7000 out of pocket, they are refusing a surgery that I need. I make about $37,000 a year and now because of the pain I am physically unable to work. I can not go to work high on doctor prescribed narcotics and I can not work because of the pain. Dr. Boland says the pain will go away if the surgery is performed, also from having a crushed disk rubbing bone on bone my vertebrae are trying to fuse themselves together and if this happens I will be crippled. I Do not want to be disabled, I want to work. If I do not have this surgery I will lose my job. My doctor and I have both appealed their decision and still have been denied. I also filed a formal complaint with the Missouri Insurance Consumer complaints department. If I end up losing my job and on disability because of the insurance company denying my claim would that be grounds for a lawsuit against them? I have extensive medical documentation to support my claim.

Carl McLaughlin.

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