Every year, thousands of New Yorkers appeal their insurance company's decisions not to cover their medical care. Appeals are submitted to the New York Department of Financial Services ("DFS"), which determines whether an insurance company acted in a patient's best interest. If DFS decides that the insurance company did not act in a patient's best interest, the insurance company's decision is overturned and the insurance company is required to pay for the previously denied service.
In August 2016, Berke-Weiss Law PLLC submitted a FOIL request to DFS to get redacted versions these decisions. Starting in March 2017, DFS began to provide redacted 2015 appeal decisions. They will be releasing them to us throughout 2017, and we will be adding them to the database below. This is the first time that the decisions have been made public.
If you get a denial from your insurance company, you can search the decisions to see what other patients with similar situations have experienced. Note that these decisions do not set precedent, because each reviewer looks at each set of circumstances anew, but you can see how reviewers looked at different situations, including which medical standards on which they rely. This information may help you evaluate how to proceed in your case.
You can browse below, or download the document to search by keyword. If you need assistance preparing an insurance appeal, you can contact us for a consultation.