NATIONALLY RECOGNIZED. CHICAGO STRONG. HEALTH INSURANCE LAWYERS

Bartolic Law helped a client suffering from Multiple Sclerosis get continued treatment with an expensive medication after the insurer cut off payment for the treatment. The medication costs approximately $10,000 per month, and the insurer paid for it for 6 years. Then it abruptly stopped covering the medication, asserting it was not medically necessary, as treatment with that drug ordinarily does not last longer than 2 years. We were able to show that the insurer’s guidelines were not in line with medical necessity and that the past 6 years of treatment had helped the client. We were able to resolve the matter for the client so he could continue to manage that devastating disease.

Health benefit plans often cover medical expenses incurred when you suffer an injury caused by another person, but then get reimbursed from the settlement. The plans often state they will exclude any further treatment for the injury. Bartolic Law helped a client get a costly surgery to remove a spinal cord stimulator removed when the plan denied the claim. The plan contended that because the spinal cord stimulator was inserted due to the third-party caused injury, any further treatment related to the spinal cord stimulator was excluded as “caused by the same injury.” We demonstrated that the reason the client needed the stimulator removed was that she fell down stairs in her own home years after the car accident, causing an infection at the site of the stimulator. Her doctor advised if she did not get the device removed immediately, the infection could migrate to her spine and cause permanent damage. Using detailed accounts of the in-home accident and progression of the infection, we won the case in court and obtained full relief for our client.

Bartolic Law helped a client who was pregnant when her employer changed health insurers, but it never enrolled her with the new insurer despite collecting health insurance premiums from her. The employer appeared to just forget to include her, and when she delivered her baby, the previous insurer denied the claim because it was no longer the insurer, and the new insurer denied the claim because the employer did not enroll her. We were successful in getting the employer to cover the medical costs, subject only to contribution from our client equivalent to what she would have paid had she been enrolled in the insurance.

Bartolic Law represented a client that had herself and her terminally ill husband enrolled in the employer’s health insurance plan. The employer fully insured its health benefits, until a broker approached the employer and proposed to save the employer money by structuring the health plan as self-insured with stop loss insurance (which operates like very high deductible health insurance for the employer). After adopting the new plan structure, and our client’s husband’s astronomical bills were not being paid, the client learned the broker and the third-party administrator never bound the stop-loss insurance, yet disclaimed any responsibility for doing so. In a brilliant opinion, Judge Johnston wrote: “[I]f the allegations made by the plaintiffs and third-party plaintiff are true, then this case is a prime example of why so many people are so enraged with the health insurance system.”

Bartolic Law helped who required surgical modification to her labia to permit her to conceive a child through natural intercourse. The insurer denied the claim, contending the surgery was cosmetic. Thanks to our client’s trust in us, and our professionalism, we were able to show the insurer why the deformity required surgery for a medically necessary reason and was not a cosmetic procedure.