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Underpaid Health Insurance Claims

Underpaid Health Insurance Claims Lawyer

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Underpaid Health Insurance Claims

Health insurance is essential to all Americans. Without it, it would be impossible for the average person to obtain the medical care that they need.

Health insurance covers not only routine, expected expenses like doctor’s visits and laboratory tests, but also emergency care when an accident or a serious illness strikes.

Without insurance, people would have to pay several thousands of dollars for things like surgeries, hospital stays and physical therapy. However, such care remains expensive even for people who do have insurance.

This is too frequently because insurance companies act in bad faith or make costly errors. If you are burdened with medical bills that you believe should be covered by your insurance, then you need the assistance of a health insurance claims attorney.

At Your Insurance Attorney, we represent people just like you whose health insurance company has underpaid them on a claim. Sometimes, this underpayment is the result of a misunderstanding on the part of the insurer’s representatives. Or, perhaps they aren’t correctly interpreting the terms of your policy.

There’s also a chance that your insurance company may be acting in bad faith. 

Regardless of the circumstances, you owe it to yourself and your family to have the situation reviewed by an experienced underpaid health insurance claims lawyer.

What Are Your Options When a Claim Is Underpaid?

Even if your insurance company is large and well-known, there’s little guarantee that they will act in good faith. Adjusters and other insurance company representatives may make mistakes with regard to your health history, the specific treatments you received and the precise terms of your coverage.

Even worse are those instances in which an investigation brings to light a widespread practice of underpaying on health insurance claims. Essentially, your insurance company is out to protect its bottom line. They are betting that their customers will accept an inadequate payment as the final word, and then move on with their lives.

After all, the average consumer isn’t an expert when it comes to health insurance. They may not know that there is an appeals process or that someone with legal knowledge might be able to negotiate with the insurance company to obtain a more favorable outcome. They certainly don’t have the expertise that’s required to understand the legalese that is written into every line of an insurance policy.

Why You Need a Health Insurance Attorney for Underpaid Claims

Too many people accept whatever money their insurance company offers them without question. That is the case even when the settlement doesn’t begin to cover their health care expenses.

If you have concerns that your claim was underpaid, then it’s only sensible to speak with a health insurance claims attorney. These legal professionals possess an unusual level of knowledge with regard to the terms of insurance policies. Moreover, they understand the procedures used within insurance companies.

Because of their background, they are adept at identifying all of the typical parts where errors or misinterpretations of the policy terms occur. Their years of experience further enable them to determine whether or not a particular insurer has a demonstrable practice of underpaying on claims.

The practitioners at Your Insurance Attorney stand ready to defend your rights before your insurance company and before the courts, if that is necessary.

When Should You Call a Health Insurance Claims Lawyer for an Underpaid Claim?

If at any time during the claims process you believe that your insurer is stalling, delaying or offering you an inadequate settlement, then it makes sense to call an attorney.

This applies even if you have already accepted an amount that you believe is incorrect. Your Insurance Attorney understands that you may have thousands of dollars in medical bills hanging over your head. Perhaps you have already tried to pay them by using your credit cards and emptying your savings account.

Accepting an inadequate settlement from your insurer may have seemed like the only option at the moment. However, if your insurance company acted in bad faith or made an error, then they legally owe you additional funds.

You have the right to appeal your insurance company’s decision, and Your Insurance Attorney can lead the fight.

What the Health Insurance Industry Gets Wrong

Health insurance companies love to use fine print, loopholes and technicalities to deny or underpay claims. Their representatives may decide that a certain condition was preexisting and therefore not covered by the policy. Or, perhaps some of the paperwork went missing. Additional documentation and evidence are required.

The process can go on for months. Meanwhile, your family struggles financially. As you try to heal and get back to normal, your insurance company is giving you the runaround.

When they do finally offer a payment, it’s not nearly enough to cover your bills. Of course, there are also times when a claim is outright denied. This leaves you to foot the entire bill yourself.

Health insurance shouldn’t work this way, and that’s why there are law firms out there like Your Insurance Attorney.

Demanding Justice for Clients

Your Insurance Attorney has years of experience helping families like yours receive the health insurance benefits to which they are entitled. With in-depth familiarity with regard to interpreting insurance policies and how the law is applied in these matters, it is possible for our practitioners to help you get back on your feet.

Building a strong case that convinces the insurer is rarely an easy task. Fortunately, Your Insurance Attorney has the resources that are necessary to fully investigate your claim to determine how much coverage you are entitled to.

This enables us to negotiate with your insurance company, tactfully pointing out where errors may have been made and holding the line against bad faith practices.

If these negotiations fail, then we are experienced courtroom attorneys who will use our legal acumen to argue your case before a judge, if necessary.

Your Insurance Attorney never gets paid until you do. If you believe that your insurance company has offered you a lowball settlement, then you need a competent health insurance claims lawyer. 


What is a health insurance denial?

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.

What is an Explanation of Benefits?

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.

What type of health insurance do I have?

There are four general type of plans (i) marketplace plans (ii) employer plans (iii) self-insured plans (iv) short-term plan.

What happens if my health insurance fails to approve a medication or treatment?

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.

What is a health insurance appeal?

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.

I have a large bill because my health insurer failed to pay for my medical bill, what next?

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.



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