Joseph Romano Law

I represented a family whose child had cerebral palsy. The treating doctor at the pediatric rehabilitation facility requested an extension of stay from the managed health care insurer. The insurance company refused to pay for additional in-patient rehabilitation days based on a "treatment or practice guideline" that was prepared by a private for-profit publishing company. I argued that the "treatment or practice guideline" was based on non-existent or faulty science, and that using such guidelines amounted to bad faith/unfair insurance practice. The insurance company reversed its decision and agreed to pay for an extensive rehabilitation stay

.Insurance companies who refuse to pay for short-term and long-term rehabilitation benefits, or any benefit based on "treatment or practice guidelines" should be fought aggressively by families and health care providers. Often, the insurance companies do not have written treatment or practice guidelines or, as in this case, a scientific basis to support their decision.