Being denied appropriate health care services can leave you feeling hopeless. If you are convinced your health plan is wrong and you think that delay could be harmful, get the care first and then hold the health plan accountable. Your odds are better when you are alive.

Denials of coverage happen with alarming frequency every day, but only a few make the news. A recent Hawaii Supreme Court ruling has shined a spotlight on the problem. The news brings us awareness of threats, and how to avoid them.

So what should you do when you have been denied coverage for a medically necessary treatment or a diagnostic procedure such as an MRI?

First, do not cede power to a health insurer. If your doctor believes you should have a treatment without delay, get the treatment and appeal the denial later.

Here’s a concrete example of a grandfather I knew: A health insurer dithered about whether to approve an emergency treatment for his granddaughter for a potentially deadly, previously diagnosed birth defect. The grandfather sat in the emergency room with her for a terrifying hour. When the grandfather believed he could safely wait no longer, he scooped up his granddaughter and raced to another ER nearby, where she promptly received the treatment and lived. The health insurer was ultimately ordered to pay the ER’s $25,000 bill plus attorneys’ fees.

Be your own grandfather. Your doctor can support your appeal with better proof if your treatment was successful. If the health insurer and your doctor do not have a productive conversation after that, you are in a good position to press your claim through legal options.

Doctors are your best front-line advocates because they know their patients and medical necessities better than the health insurer who is not a health care provider. Health insurers have for many years disseminated suspicion about doctors prescribing unnecessary treatments whenever they can. The claim is unsupported by the evidence.

Then we come up against the issue of “managed care.” In managed care, the insurance company is in charge of your health, not your physician. Instead of practicing independently and billing several competing insurers, your doctor shares financial interests with one insurance company. There is good routine medicine practiced in the managed care model, but sharing a financial interest with the insurer pits medical judgment against the costs of expensive treatments or equipment, adequate staffing to support treatment, or the necessity of a referral to specially skilled unaffiliated specialists or transfer to a special facility.

If you find yourself literally fighting for your life, paying for the care yourself may be your only option. You could be on the hook for a diagnostic procedure or even an expensive treatment or therapy. If the diagnostic procedure finds something that would not have been found without it, or if the treatment is successful, that could be substantial evidence that the health plan’s denial was wrong. There have been cases in which courts have ordered health plans to retroactively reimburse members who have chosen to pursue treatment going against a health plan’s position because, as it was with the grandfather, delaying or accepting a denial treatment was clearly not the right choice.

We have to refuse to die or be rendered disabled; be steadfast and use the rule of law to stand up to powerful opponents. When it is a matter of life or death, choose life.

Rafael del Castillo is a Honolulu-based attorney who has represented numerous patients in health insurance claims.