There are certain conditions which managed care companies look to use one of these tactics to not pay for benefits. Unfortunately, often the contract between your employer and the managed care company will limit benefits for certain conditions. It is possible that if the contract has been well written by the company's attorneys they will not have to pay for these more expensive but crucial treatments. Companies routinely deny this care, either calling it experimental or investigational, or denying its medical necessity. Such denials must be aggressively and swiftly challenged due to the life-threatening nature of the disease.
Court injunctions are possible, with the court ordering the company to pay for the care.
Your provider should request an immediate expedited appeal of any denial. An attorney must be contacted if the company delays providing such an appeal. Companies often attempt to limit benefits for mental health treatment, particularly outpatient psychotherapy to fewer sessions than the contract allows the individual. This is especially true if there is a history of use of psychotherapy services. Obtaining approval for substance abuse treatment is often problematic because companies may use improper criteria for determining eligibility or fail to provide rehabilitation although providing short-term detoxification.