What can be done where insurance coverage for necessary medical treatment is denied? For those covered by a policy obtained through their employment the answer is almost surely not very much. For the vast majority of individuals and families whose health insurance comes through employment, their policies are covered by the federal law known as ERISA. Where insurance coverage is wrongfully denied under a policy subject to ERISA, the only thing that can be done is to sue the insurance company for the cost of the denied treatment. Meanwhile, of course, the person who needed the treatment may die without it.
The Los Angeles Times, "Righting Wrongful Denials of Insurance Coverage," suggests that two elements could be included in health care reform that would help in these situations: (1) more consumer choices among insurance companies; and, (2) better guidelines about necessary and appropriate treatments.