BC Advantage - 2023 Issue 5

Medical Necessary Denials

In 1988, Samuel and Winona decided to have a baby. Samuel, worked at a small sneaker factory outside of Boston where they treated their employees well by providing health insurance as part of their employment.  The factory was not a government employer, or a church which meant that the health insurance was protected by the Federal law and Federal Regulation known as the Employee Retirement Income Security Act (ERISA).  Nick's mom, Winona, went to her normal prenatal visits (in-network) at her hospital in Boston using the employer provided health insurance.  The only financial responsibility that the...

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