Our client, facing a terminal diagnosis, was denied coverage for a vital organ transplant by their health insurer. The insurer deemed the procedure “investigational” and “not medically necessary,” citing restrictive policy language and internal clinical guidelines that contradicted established national standards of care.
The client was trapped in a perilous bureaucratic limbo, with the insurer’s appeals process threatening to exhaust the narrow window of time in which the transplant could be successfully performed.
We overcame this by launching an immediate, multi-faceted legal and medical advocacy campaign. We filed an emergency injunction to prevent the insurer from delaying care further while simultaneously building an airtight case. We compiled affidavits from leading transplant specialists, who affirmed the procedure was the only viable treatment and was supported by extensive clinical data. Concurrently, we meticulously dissected the insurance policy, demonstrating that the denial was based on an arbitrary interpretation that violated both the policy’s own terms and state laws requiring coverage for recognized treatments.
By presenting an urgent, undeniable case of medical necessity supported by top-tier expert consensus and clear legal precedent, we compelled the insurer to reverse its decision just days before the scheduled surgery.
Result: Our client received the approved, life-saving transplant. The swift legal action not only preserved their health but also set a precedent within the insurance company for covering similar critical procedures.