ABA Family Legal Guide

Health-Care Law

Health-Care Options

Health Insurance and Managed Care Organizations

Can I sue my health plan to recover the cost of my treatment?

ERISA does not bar claims for economic loss based on the denial of benefits. In other words, you can sue your health plan to try to get it to cover your medical bills. Any amount you are awarded is limited to the amount of the medical services that are disputed and your lawyer's fees. If you have a bill for $2,900, that amount and the cost of your lawyer's fees is all you are allowed to recover from your health plan. To win coverage for medical bills, you will have to show that you complied with your health plan contract. If you go to the emergency room for a migraine at a time when your doctor is holding office hours, even though this is clearly not allowed under your policy, you may not be able to get coverage for those medical bills.