[Texas-T]

My fiancee, Jeff, is working on a paper for Grad school about insurance companies denying procedures approved by the FDA (like ADR) and could use a few leads. Any help would be greatly appreciated.

Does anyone know what gives insurance companies the right to deny ADR a FDA approved procedure? (i.e. is there a law that allows them the to pick and choose what they'll cover?)
Does ERISA allow insurance companies the power to deny FDA approved procedures?

I was very lucky and Aetna approved my ADR after little fan fair. (I was previously denied by UNHC) Does anyone know why some companies will pay for the surgery, while other's won't?

We understand the appeals process, but do you have the right to sue your insurance company if they deny you after following through with the appeals process? Our understanding thus far is that if you are not a federal employee you must sue in Federal Court where you are at a disadvantage and are not elligable for $$$ for pain and suffering. (b/c of ERISA) If you are a Federal Employee you can sue in State Court. Does anyone know if this is correct?

I know this may be a little complex... so any leads would be helpful.

Thanks again for the help.

Tricia