Health insurance companies tend to be vicious when it comes to claims. Since healthcare costs are so expensive in the United States, insurance companies will look for any excuse not to pay claims that are filed by their policyholders. That is how they can maximize the most profits for themselves.
Before the Affordable Care Act was passed in 2010, health insurance companies could deny claims due to preexisting conditions. Fortunately, it is against the law for them to do that now. But there are still several other excuses that they can try to use to deny your claim. If you have a valid health insurance claim and it is denied by your insurance company, you don’t have to tolerate that decision.
The Louis Law Group has an experienced team of health insurance denial lawyers who can assist you. Health insurance policies have so many terms and conditions. We will review all the fine print of your health insurance policy to determine what kind of care you are entitled to receive. Health insurance companies never expect their policyholders to read all the fine print, which is why they try to deny claims unjustly. They’re hoping the claimant never discovers the truth about their rights in the case.
If we find out that your claim was denied unjustly, then we will contact your insurance company and present the evidence to them. In most cases, they will automatically reverse the denial and proceed to pay the claim. They’ll probably attribute the original denial decision to a “clerical error” without admitting their true intentions. Only an experienced team of health insurance denial lawyers can influence insurance companies to reverse their decision on a denied claim.
Reasons for Health Insurance Denials
Health insurance companies may come up with several different reasons to deny your claim. Some of the most common examples are as follows:
- You need an expensive and specific type of surgery that your insurance policy doesn’t cover.
- You visit the emergency room instead of an urgent care center, and your insurance company states that your problem wasn’t serious enough for emergency care.
- You try to purchase expensive brand name prescription drugs instead of generic drugs. The insurance company argues that they only cover generic drugs.
- There is a provision in your insurance policy that specifies a “waiting period” before you can file a claim. There may be other specific terms associated with the provision that you must follow before filing a claim.
If you need a simple doctor’s checkup, then your claim will usually get paid because it doesn’t cost the insurance company that much money. But when you need to go to the hospital for surgery or some other serious medical treatment, then it becomes very costly for the insurance company. They could be looking at five to six figures in expenses, so you can imagine why they’d want to deny a claim of that size.
What is Your Financial Responsibility?
You have a responsibility to understand the basics of your insurance policy. For instance, you should know the amounts of your deductibles, copays, coinsurance, prescription drug prices, and so on. If your insurance company doesn’t pay your claim because you didn’t pay your deductible, then you cannot turn around and expect the denial to be reversed.
You have to meet your financial responsibilities when it comes to claims. That means paying the necessary deductibles, coinsurance, or copayments that you’re expected to pay under your policy. If you satisfy these financial responsibilities, but your insurance company doesn’t fulfill their financial obligations from your policy, then you can start putting legal pressure on them with our help.
Contact a Lawyer Today
We offer free consultations with all new prospective clients. You are under no obligation as we evaluate your case and determine whether you have grounds for a reversal on your denied claim. If our lawyers find that you do, then we can proceed to represent you in your claim denial case.
It is rare for claim denial cases to go to court, but we will take it to court if we feel that it is warranted. However, health insurance companies will always try to avoid going to court whenever possible. It is less expensive for them to pay an insurance settlement than it is to pay a civil judgment. If you have a valid case for a claim denial reversal, they won’t try to fight it. Not while we’re representing you in the matter.
