Multiple Sclerosis Coverage Delays: When Insurers Stall DMTs, Infusions, MRIs, or Specialist Care
If you or a loved one has experienced worsening multiple sclerosis because the insurance company is keeping you from getting the care you need, you may be able to file a lawsuit. The Orange County insurance bad faith lawyers at Quincey Law can lead the fight on your behalf.
When one has been diagnosed with multiple sclerosis, the timing of the medical care that they receive can affect their quality of life going forward. Timely and intensive treatment can slow the progression of the disease. At the same time, coverage delays or outright denials can result in a patient’s condition worsening quickly in an irreversible way. If the insurance company has delayed coverage in violation of California law, it can be held liable in a bad faith lawsuit.
Learn how you can fight back directly against the insurance company for the harm that their actions have caused you by scheduling a free initial consultation with an Orange County Insurance bad faith lawyer by reaching out to Quincey Law at (866) 945-9175. They may have put their profit motive ahead of their contractual obligations, but you can make them pay for it.
Immediate and Intensive Care Is Vital for Multiple Sclerosis
Multiple sclerosis is a progressive condition in which your immune system attacks the protective coating around your central nervous system. These attacks result in inflammation. When this inflammation is left unchecked, it can cause lasting and permanent damage to the nervous system because the damaged nerves cannot repair or regenerate themselves. It is crucial that a patient undergoes intensive early treatment to both slow the progression of the disease and to reduce the instances of Inflammatory attacks.
Accordingly, a multiple sclerosis patient may need expensive disease-modifying therapies and diagnostic tests early after diagnosis. These treatments may include the following:
- Injectable Therapies
- Oral medication
- Infusion Therapies
There is no way around the fact that these treatments are prohibitively expensive. Studies show that DMTs can cost an average of $100,000 to $150,000 per year. At the same time that you incur these treatment costs, you must also pay for expensive tests, such as MRIs, as well as specialist care. Having health insurance is supposed to significantly reduce these costs due to caps on a patient’s contribution. However, it does not always work this way in practice.
Multiple Sclerosis Can Be Made Worse By Treatment Delays
Multiple sclerosis is a disease that is known to attack, pause for some time and then relapse. If you delay DMTs early in the course of the disease, there is a much higher chance that you will experience a relapse. Simply stated, weeks matter when it comes to the treatment of multiple sclerosis. Even one relapse is enough to cause permanent damage from which you may not recover. It may only take months of delayed treatment to place you in a state where you are more susceptible to permanent damage. If the insurance company does not promptly approve and cover your claim, they are leaving you in a vulnerable state and risking the chances of an irreversible condition.
Insurance companies are known for unreasonably denying claims that they believe are not medically necessary. This is not the only way that an insurance company’s conduct can result in a worsening of your multiple sclerosis. Insurance companies may also cause you harm by delaying approval of the claim. They may also complicate your getting the care that you need by not paying claims in time, jeopardizing your ability to receive continued treatment from your provider.
You Can Hold the Insurance Company Accountable for a Wrongful Denial
California allows you to sue an insurance company directly for multiple prohibited practices. The state’s bad faith law requires that the insurance company promptly acknowledge and investigate any claim. They cannot unreasonably delay payment of your claim. They can be liable to you directly in a bad faith lawsuit if they have engaged in any of these prohibited practices.
If you are able to prove that you suffered harm from the insurance company’s unreasonable delay of your critical early intervention for multiple sclerosis, you may be entitled to substantial damages. These can include:
- Medical expenses to treat your worsened condition
- Pain and suffering for what you have endured due to delayed claims
- Lost wages if your condition has left you unable to work
- Potential punitive damages for egregious conduct
You cannot and should not let the insurance company get away with wrongful conduct that may have contributed to the unnecessary progression of your disease. They can be made to pay for far more than just the medical care that you need.
Contact an Orange County Insurance Bad Faith Law Firm
An Orange County Insurance bad faith attorney at Quincey Law can review the circumstances of your case and help determine whether the insurance company has broken the law. Speak with one of our attorneys during a free initial consultation, which you can schedule by filling out our online contact form or by calling us today at (866) 945-9175.
Nicholas Quincey is the founder of Quincey Law, and has over a decade of experience of handling insurance claims denials and personal injury matters for people throughout California. We have pursued insurance bad faith claims for people involving life insurance, health insurance, homeowners and disability insurance. We also work with clients and families who need assistance filing and pursuing a personal injury matter. Learn more here.