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Re: [IP] Coverage for pump education classes-what does it cost?

> On Tue, 27 Jun 2000, Michael wrote:
> > Don't worry yourself about it, just get a written denial, and file an 
> > appeal. Let them know in plain but polite terms that they can pay the 
> > bill or you will be happy to sue them for breech of contract -- this 
> > is not a denial of benefits issue, but a matter of contract law. You 
> > can probably even take the matter to small claims court if you wish.
> This is good advise, but you have to be careful with it.  In the
> state of AZ you cannot sue your HMO.  You have to sign a contract
> when you first sign up that says this.  All you can do is keep
> filing the complaint here!

The interpretation of this varies. I believe is says you can not sue 
them for denial of a medical benefit. That is very different from 
breech of contract where they have agreed to provide a service then 
fail to do so pursuant to the terms of the contract. This is the 
gotcha for them. The can not afford to lose this kind of suit because 
it will open a flood gate. Usually these matters magically get 
settled quickly.
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