Case Results

Denial of health insurance benefits reversed

Rodriguez v. United Health Corporation, Fair Hearing # 5916974P

Rosenberg & Rodriguez represented a patient in a dispute with United Health Care Insurance Co. (UHC) stemming from UHC’s denial of health insurance benefits. The patient was scheduled to undergo a surgical procedure and the patient’s physician requested approval of a 2 – 3 day hospital stay following the surgery. UHC, while approving insurance coverage of the surgery, denied the physician’s request for the in-patient hospital stay. UHC argued that the procedure was ambulatory and that an in-patient stay was unnecessary.

R&R, on behalf of the patient, appealed the decision. During a recent administrative hearing, R&R provided medical studies and other evidence to successfully demonstrate that the in-patient stay was appropriate and necessary. The administrative judge agreed with R&R’s position and the denial of coverage was reversed.