It is no secret that health care is incredibly expensive in America. Accordingly, most people get health insurance through their workplace or on their own to help defray these costs.
Unfortunately, too many insurance companies seem to be more interested in protecting their bottom line than they are in making certain that their clients receive the best available medical care.
Health insurance is supposed to help pay for things like routine doctor appointments, vaccines, lab tests, emergency care, surgeries and hospital stays. The reality is that many insurance plans either don’t provide adequate coverage for these services or contain loopholes that let the insurer off the hook.
If you have a claim that has been denied or underpaid and you believe that your insurance company made a flawed decision, then you need to speak with a Florida health insurance claims attorney.
Your Insurance Attorney provides you with dedicated, local representation by a lawyer who cares about you and your family. He doesn’t get paid unless you do, so you can trust that he’s behind your claim 100%.
What’s more, the legal team at Your Insurance Attorney has extensive relevant experience with denied health insurance claims, making them the ideal choice when you’re fighting a denied or underpaid claim.
If a physician informs you that you require surgery or another potentially costly medical procedure, then it is frequently necessary to tell your insurance company about this upcoming treatment.
It is the job of the insurer’s representatives to investigate the procedure and make an evaluation of your claim.
In other instances, your life is in immediate danger, and there isn’t time to get approval for a procedure. This means that doctors must act to save your life or prevent serious complications. A health insurance claim is submitted after the procedure is completed.
In either case, the insurer may decide to deny your claim. When pre-approval is requested for a procedure, the insurer may deny the claim. This causes far too many people to forego necessary medical procedures that could help to preserve their health and life.
When you receive emergency medical attention, you’re frequently in no position to refuse medical treatment if you believe that the procedure won’t be covered by your insurance. This means that you must take your chances by submitting a claim after the fact.
If the insurance company refuses to pay, what can you do?
The complex nature of health insurance claims means that you nearly always need a competent attorney when you are fighting a denial. Too many people just accept the insurer’s denial, and then they don’t get the critical care or prescription medications that they need.
When you receive notification from your insurance company that a claim has been denied, it does not have to be the end of the story. Insurers look for any loophole or technicality that will allow them to deny a claim.
This means that insurers sometimes violate the policies that are held by their customers. Just as commonly, the insurance company representatives make errors in interpreting what your policy covers and what it doesn’t.
This is why it’s always worthwhile to consult with a health insurance claims attorney in Florida. These legal professionals will review your policy. Thanks to their familiarity with the law and terms that are commonly used in insurance policies, they are able to determine whether or not an error has been made.
Accordingly, your attorney can point out the errors to the insurance company and work with them to get you the protection that you need. If the insurer persists in their error, then it is possible to file a lawsuit to defend your rights.
Keep in mind that the vast majority of lawsuits never make it to the trial phase. It is far more common for the parties to settle during the discovery period when both parties are disclosing documents and holding depositions. This means that you can get the insurance coverage you need while also avoiding a courtroom battle.
Because of their experience practicing in this area of law, an attorney can use their background to appeal the decision made by your insurer. This means that they review your claim and the terms of your policy, enabling them to put together a strong case for appealing the denial.
Another helpful aspect of engaging a denied health insurance claim attorney is that they understand the typical procedures that are in place at insurance companies. Accordingly, they don’t waste time corresponding with representatives who don’t have decision-making power, or get tangled up in a lot of red tape and bureaucracy.
In fact, chances are good that Your Insurance Attorney has represented clients against your insurance company before. This provides them with priceless insight into the procedures of that insurer, making the appeals process quicker and more efficient.
Perhaps the most obvious benefit of hiring a lawyer is that you gain an advocate who does all of the hard work for you. If you are ill or are recovering from a medical procedure, you need to focus on getting well, not fighting with your insurance company.
Let Your Insurance Attorney take the reins while you concentrate on recovery. You will probably get a better outcome and experience far less stress while getting there.
Has your health insurance claim been denied? Have you been told that your insurance only covers a small portion of a required procedure?
If so, then talk to the practitioners at Your Insurance Attorney. They’ll never ask you for any payment unless they get compensation for you. Accordingly, you can trust that they are always 100% on your side and ready to fight for you.
No matter what stage your claim may be in, it’s not too late. A denial doesn’t always have to be the final word. Let a skilled attorney review your claim.
A denial is when your health insurance company tells you that it will not cover the costs of your medication or medical treatment. Many health insurance denials may be resolved through the insurance appeals process.
An EOB is a statement from your health insurance plan describing what costs it will cover for medical care or products you’ve received. The EOB is generated when your medical provider submits a claim for the services you received. The insurance company sends you an EOBs to clarify (i) The cost of the care you received (ii) Any money you saved by visiting in-network providers (iii) Any out-of-pocket medical expenses you’ll be responsible for (iv) any cost sharing under your contract of insurance.
There are four general type of plans (i) marketplace plans (ii) employer plans (iii) self-insured plans (iv) short-term plan.
You will have to review your policy and EOB to determine the reason for the denial. If you find an error was made, you may submit an appeal for re-consideration of the decision. There are typically three levels of appeal. The First Level, A second Level and an External Review. If your claims are denied at all levels, legal action is the next step. Employer plans are the only health plans that require an appeal. Unless the health policy says otherwise, an appeal is not mandatory for other health insurance plans.
If your health plan refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party. There are typically three levels of appeal. The First Level, A second Level and an External Review. If your claims are denied at all levels, legal action is the next step.
If you have an employer plan the next step is filing an appeal. You must be aware of time limits to file an appeal. Failure to file an appeal may bar your claim and any legal action in the future. If you have a short term plan or a marketplace plan, an appeal is not usually mandatory and you can proceed to legal action after 60 days have elapsed from the date the claim was denied.