Does anybody know if I could sue my insurance company for not providing benefits for tmj? They provide benefits for every other joint. Any thoughts?
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Can you sue your insurance company?
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 Michelle Denise |
Can you sue your insurance company? |
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Posts: 6580 (05/16/05 19:05:05) Senior Member
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am6845 |
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Posts: 353 (05/16/05 19:51:29) Member I |
Check in your evidence of coverage book in the back it will say what you have to go through First. But the answer to your question is Yes if they failed to provide medically necessary treatment then I say yes. Contact a Lawyer that will give you advice without taking any money.
MHO Angi www.tmjfacialpain.com/medicalegal.htm www.tmjoints.org/policy/TMJState.htm www.tmj.org/insurance3.asp# I think we have all seen these |
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Michelle Denise |
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Posts: 6580 (05/16/05 20:11:33) Senior Member
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Thanks for the links.
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am6845 |
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Posts: 353 (05/16/05 20:16:43) Member I |
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Elaine2004 |
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Posts: 2777 (05/16/05 21:12:43) Senior Member
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Michelle, Check in the yellow pages of the phone book. A lot of lawyers have first consultation free. They should be able to tell you if they think you even have a chance.
Elaine |
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Michelle Denise |
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Posts: 6580 (05/17/05 13:40:23) Senior Member
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Thanks Elaine.
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ellitoid |
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Posts: 491 (05/17/05 14:27:52) Member I |
hey Michelle i agree we are form the same state but my question to you is should we sue the insurance company for not providing it or the state for not mandating that they provide it? can you sue your state? tmj is not madated in the state of mo so the insurance co. do not haev to cover it so they do not and if they do it is very little coverage liek a 1500 max lifetime or something liek that, I could use 1,500 in on visit with my dr or ti would only cover a few pt treatments or one splint. so let me know what you find out i wil be interested in it. I owuld help you search but my deck is full with the mri of my c-spine coming up tomorow and the brain one soon to follow.
sharon |
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Michelle Denise |
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Posts: 6580 (05/17/05 14:36:40) Senior Member
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Sharon,
I will let you know if I figure out anything. I am going to be gone on vacation until Memorial Day, so it is going to be awhile. |
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atibbert |
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Posts: 658 (05/17/05 15:26:12) Senior Member |
Michelle
I am fortunate enough to have good coverage, but many do not. I think if enough TMJ sufferers start speaking up and start taking these insurance companies to court, that maybe things will start to change. I know of one successful case in CT that was won. This is a medical condition like any other medical condition. An insurance company would not think of denying coverage if someone's knee joint looked like your TMJ did. And your TMJ does so much more than a knee does! Noone wants to be first, in taking on these monsterous companies, but it needs to start with someone, why not you? Hopefully one day all states will mandate coverage but until then, I think that we all need to take them on one at a time. I think it would make a great pro bono case. Good luck. Amy |
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Elaine2004 |
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Posts: 2777 (05/17/05 16:23:14) Senior Member
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I think insurance is such a racket. Doctors and lawyers stick together.... I posted once before about a friend of mine who had back surgery. She contacted a horrible staph infection in the hospital. It did a number on her spine. She kept complaining about the pain and they thought she just wanted drugs. I went in to see her and she didn't even know who I was. They gave her drugs alright. I took one look at her and told her husband to get her to Billings and out of that VET STOP Thank god he listened to me. They took her to Billings by ambulance. The doctor said she was in a coma and ready to cash out.(Those were his words) She thanks me to this day for saving her life.
Back to the point.....She talked to several lawyers. None of them would take her case. I don't understand it. They have a problem when it comes to sueing doctors or hospitals. I mean this was pretty obvious...Staph infection and all???? Doesn't anybody deserve compensation when something like this happens??? Where is the justice? Elaine PS. For anybody interested, I started a spinal disorder thread under Medical conditions. Problems with neck etc. |
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Michelle Denise |
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Posts: 6580 (05/17/05 20:40:03) Senior Member
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We are just looking into it. I don't know if anyone would take the case without a fee. We would have to do it that way. I filed a complaint with the MO Insurance Commission. I am also working on a letter to our governor. Nothing may come of any of this work, but I know I did my best.
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vanny1961 |
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Posts: 343 (05/17/05 22:17:22) Member I |
I think I had posted this one other place, but maybe not. There are some interesting cases here. I think maybe I got this link from GoodwillStacy.
Karen www.tmjfacialpain.com/medicalegal.htm |
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Michelle Denise |
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Posts: 6580 (05/18/05 22:41:54) Senior Member
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Thank you for your help.
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Michelle Denise |
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Posts: 6580 (05/28/05 13:27:20) Senior Member
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We are a peer support group. We hope you find this Group helpful in learning about this disorder and sharing your experiences.
Disclaimer: We cannot replace a Professional Diagnosis by a Doctor or Dentist, nor can we suggest appropriate treatment. We strongly encourage everyone to see a Professional for diagnosis and treatment regarding Temporomandibular Joint Problems.
Disclaimer: We cannot replace a Professional Diagnosis by a Doctor or Dentist, nor can we suggest appropriate treatment. We strongly encourage everyone to see a Professional for diagnosis and treatment regarding Temporomandibular Joint Problems.
