Anyone who has had to undergo a doctor’s visit and laboratory testing in recent years knows how expensive these routine procedures can be. It’s exponentially more costly when you, or someone in your family, requires hospitalization and surgery. The medical bills can easily run into the hundreds of thousands of dollars.
When expensive medical tests and procedures are required, people rely on their health insurance to help make that care more affordable. Unfortunately, not all insurers are as focused as they should be on protecting their client’s best interest.
The result is delayed and denied health insurance claims. This means that you may be stuck with large amounts of medical debt that you expected your insurance to cover. What do you do now?
Terms such as co-pay, patient financial responsibility, out-of-pocket maximum, deductible and out-of-network can sound like a foreign language to anyone. But to an insurance agent, they are as familiar as the alphabet.
They’ll use these terms and others similar when they are looking for ways to deny a health insurance claim. It’s enough to leave the average consumer with a headache.
Fortunately, insurance agents aren’t the only ones who speak this language. A health insurance claims denial lawyer is just as familiar with these terms as any insurance representative.
What’s more, a legal professional who has experience with health insurance claims understands the laws that support every insurance policy. This enables them to interpret the policy language in light of the applicable law.
Consequently, these attorneys can present cogent legal arguments that are designed to convince insurance companies that they are wrongfully denying a claim. If this does not succeed, then the attorney has the power to take the insurance company to court.
Like any other business, a health insurance company exists to turn a profit. Accordingly, they are happy to collect a client’s insurance premiums on a regular basis.
When the money needs to flow in the other direction, things tend to get slow and confusing. The insurance company wants to conduct a thorough investigation of the medical bills to determine which expenses are covered or not covered by the policy. This review takes time, and this means that the policyholder is being forced to wait while the bills keep growing.
Still, the policyholder is confident that they have good coverage. They shouldn’t end up owing too much out-of-pocket.
All too often, things don’t go as expected. The insurance company wants to pay out as little as possible. They’ll say that certain procedures aren’t covered by the insurance plan or that a physician is out-of-network, and therefore not eligible for the coverage.
The insurance company is likely to respond slowly, extending to a ridiculous degree what should be a quick and efficient process. At the end, they only agree to pay a small amount of the charges or outright deny the claim.
Ultimately, it is the insurance company’s sole interest to protect their bottom line. This means that they will look for any excuse to offer you a lowball settlement or deny the health insurance claim.
No matter where you are in the claims process, it is wise to contact a health insurance claim lawyer who works on health insurance claims. This applies whether your claim hasn’t been filed yet, as well as if your claim has been inadequately paid or denied.
Of course, contacting a health insurance claim lawyer sooner rather than later ensures a smoother, more efficient claims process. However, if your claim has been denied or your insurance company is unreasonably prolonging the claims process, then you may still benefit from consulting a lawyer.
The advantages of working with an attorney are many. These professionals are loyal only to you and your interests. They are not trying to appease an employer and a client like insurance company representatives are. Instead, their singular focus is on achieving the best possible outcome for their client.
Working with a legal professional, like Your Insurance Attorney, is different. They won’t send you a bill every month that you have to keep up with. In fact, they don’t get anything, not even a penny, unless you get paid by your insurance company.
Accordingly, you can trust that Your Insurance Attorney is completely dedicated to ensuring that you get the maximum possible settlement. This means that you have enough to pay your medical bills with, so that you can enjoy improved peace of mind.
In many cases, it’s even possible to ensure that your insurance company pays for your legal representation costs. This means that there isn’t any money coming out of your pocket to pay for high-quality legal services.
If you feel that your health insurance company is giving you the runaround, don’t wait to seek legal help. It is possible to put an end to the constant worry and stress of expensive medical bills for which your insurer refuses to compensate you for.
Case representation by Your Insurance Attorney includes a thorough review of your medical bills and health insurance policy. With a legal professional interpreting the policy, it’s possible to discover that your insurer isn’t fairly construing the contract’s terms, limits and conditions. This means that you may get the compensation that you deserve.
When your insurer tells you that certain procedures and expenses on your medical bills aren’t covered by your policy, don’t take their word for it. They may be misinterpreting the contract’s terms, limits and conditions or looking for any excuse to deny your claim.
Instead, ask Your Insurance Attorney to review your bills and policy, and state law, to know what’s covered and what isn’t. It may be the best, most reliable way to get your medical expenses paid by your insurer.
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.