Medical and healthcare bills can pile up quickly and become a hindrance in getting a life-saving treatment for you or your loved one. That is when health insurance comes in. Healthcare insurance is an investment every individual makes to ensure they get the best treatment without worrying about funds. But there are chances you may get into a dispute with your insurance company. Disputes between consumers and healthcare insurance companies are becoming increasingly common. Insurance companies can deny medical coverage, experimental treatment, paying for medical bills, or refuse to pay for visits to specialists. In such circumstances, appealing against healthcare insurance is the best way to get the money you rightfully deserve. Hiring a health insurance attorney is the best way to deal with the problem and ensuring you or a loved one is not devoid of access to life-saving treatment.
Healthcare insurance claims can be denied for the following reasons:
The best way to check the validity of a denial is to analyze your insurance policy thoroughly. If your claim has been denied due to something that is not mentioned in your policy, then your insurer may be acting in bad faith. In such cases, you can sue your insurer and demand getting your insurance, and even more if you can prove that the company acted in bad faith. To challenge the denial, you are required to file a health insurance claim appeal.
Appeals are a legal tool that enables you to request insurance companies reconsider their decision to deny your claim. The Affordable Care Act (ACA) laid down in the US constitution empowers you with the right to appeal against the claim denial and even get it reviewed by a third party. A typical appeals process has the following stages:
In most states, the process begins by requesting the insurance company to review their decision. This is done by filing an appeal with the company. Generally, the details of filing for an appeal can be found in the denial letter. You would have to fill a form provided by the company, or you may be required to write a letter to the company requesting them to review your claim once again. Along with the appeal, you are required to submit the best arguments to support your claim. This can include letters from the doctors treating you or articles supporting an experimental treatment for your condition. During this stage, the company assigns the responsibility of reviewing the claim to a person who was not initially involved in making the decision in the first place. If the claim is denied once again, you can appeal for a second review. In this stage, the insurance company must consult a healthcare professional who was not involved in the decision-making initially or during the first review. During the second internal review, you can be present while the decision is being made and bring a health insurance attorney.
If both your first and second appeals to your insurance company fail, you can demand an independent third party to review your claim without any bias. The independent third-party review entity works in collaboration with a doctor that specializes in the condition that is in question. If your claim is denied once again, you can then challenge the decision in court. Similarly, the insurance company is also given the privilege of challenging the decision.
Insurance is a contract that you sign with the company. The contract binds you to make your premium payments on time and obligates insurance companies to cover the medical expenses they commit to in the contract. If an insurance company is denying the claim wrongfully or unreasonably, they are breaching the contract. This means the insurance company is acting in bad faith. In this case, you may be entitled to receiving compensation that can be more than your medical and healthcare expenses. The following actions undertaken by an insurance company can be classified as bad faith:
If you feel that your insurance company acted in bad faith and denied your claim that you rightfully deserved, you can sue them and hold them accountable for their actions.
Hiring a health insurance lawyer helps you in the following ways:
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