Health Advocate Blog

Discover Health Advocacy: Coverage denied for an experimental treatment

We built our company, Health Advocate, Inc., to help people navigate the complex healthcare system and to provide them answers when they need them the most. Here is an example of how we have helped a member with a healthcare solution.

Problem: Coverage denied for an experimental treatment

Mike had a Metatarsophalangeal Joint (MPJ) replacement surgery that his insurance company considered experimental and therefore did not cover. He appealed, but coverage was denied.

Solution: Health Advocate gathered research documentation about the surgery and submitted a letter to an Internal Review Office. The denial was subsequently overturned based on research supporting the benefits of the procedure. This saved Mike over $11,000 in hospital fees. Soon after, the insurance company updated their medical policy to cover surgery for certain procedures they did not previously cover.