When Can Insurance Companies Deny Coverage
"This is how the uninsured die in a world full of doctors and state of the art medical equipment." (John Grishams The Rain Maker, 1996) Health insurance issues are prevalent in every day lives. When can an insured be denied health coverage their insurance company? In the movie The Rainmaker this is exactly what's being addressed. A young man is ill with Leukemia has been denied medical coverage by his insurance company for a bone marrow transplant.
Rudy Baylor, a young lawyer who has just passed the bar exam, and now has his first case, and it is going to be life a life altering trail. He is defending the Black Family who is suing Great Benefit Mutual health insurance, which is a Tennessee based health insurance company. The Black Family had purchased a health insurance policy from Great Benefit, and when their son Billy Ray fell ill, medical coverage was denied him for a bone marrow transplant. The insurance company argued that the bone marrow transplant is a new and experimental treatment and would not have any great medical benefit for Billy Ray. Therefore could not cover such an experimental treatment.
The underlying practice of Great Benefit was that they would sell health insurance door to door in poorer neighborhoods and then deny all claims within three days in accordance with the company claims manual. These people would pay there policy in cash every week. Because many of Great Benefit's clients were poor southern people, there claims were denied constantly, as was Billy Ray's who was denied on seven different occasions. The insurance company figured that these poor people, when denied coverage, would just accept the denial and not contact a lawyer.
In the process of the trial Billy Ray died. After a few savvy maneuvers by the prosecution, the case was won in favor of the Blacks. Several key issues were raised in this case, such as jury tampering, wire tapping,...