Being denied a health insurance claim can leave you anxious, stressed, and wondering how you will pay for the treatment, medical test, or prescription drug. After faithfully paying for your health insurance for many months or years, it can feel like a huge betrayal to have your insurer deny a claim for a treatment, test, or drug your healthcare provider believes you need.
If you have received a Fresno health insurance denial, you need knowledgeable legal assistance from an attorney who has taken on big healthcare insurers for many years and who will never back down from a fight. Attorney Scott Glovsky understands your situation and will work hard on your behalf to ensure you receive the care your doctor has prescribed.
Why Are Health Insurance Claims Denied?
Sometimes, the reason for a health insurance claim denial is simple and can potentially be “fixed.” For example, the claim may be missing information that can be added, and then it can be resubmitted. Your insurer may require prior authorization, or the steps required by an insurer were not properly followed.
A deadline may have been missed, or the treatment provider may not be in-network. Some procedures and prescription drugs require what is known as “step therapy,” which means cheaper or more well-known treatments or drugs must be tried and found not to work before the one prescribed will be paid for. Insurance companies often deny an expensive treatment or drug by saying it is “not medically necessary,” “experimental,” or “investigational.”
This too often means they simply do not want to pay. An insurer may approve the procedure or treatment once it has more information or after you have tried less costly measures. If this is unsuccessful, you may need a strong Fresno health insurance denial attorney like Scott Glovsky to help you get the procedure or treatment approved.
What Can You Do if You Receive a Fresno, California Health Insurance Denial?
It is important not to panic after receiving a Fresno health insurance denial. If you have fixed any clerical errors or provided additional information and the claim is still denied, you can appeal the decision. There are two levels of appeal. You can file an internal appeal, which essentially asks your insurer to reconsider its original decision.
An internal appeal may include a letter from your physician that details why the treatment is necessary. If your insurer still denies your claim, you can file an external appeal asking a neutral third party to review the information and facts and approve your claim. The decision made on an external appeal is binding on the insurance company. Filing an external appeal or taking another action such as filing a lawsuit depends on your unique circumstances and your type of health plan. That’s why we recommend you speak with an experienced health insurance denial attorney prior to filing an external appeal.
Which Insurers are Most Likely to Deny Treatments?
Unfortunately, there is no one place where you can look up an insurer’s denial rates or whether a particular company is likely to pay for a medical treatment. This lack of transparency is frustrating, particularly since state and federal regulators can change it but have so far declined to do so. Some insurers flag more expensive treatment for additional scrutiny, while others use AI to deny claims in bulk with little human review. Since this information can mean the difference between life and death or health and wellness, consumers deserve to know which insurers are more likely to deny certain claims than others. In the state of California, some of the insurers who may be more likely to deny legitimate claims include:
What Are Your Options Following a Health Insurance Denial?
You have the right to file internal and external appeals following a health insurance denial and to speak to a knowledgeable Fresno health insurance denial attorney. You pay for health insurance for peace of mind, hoping you will never need it, paying your insurance premiums faithfully to protect yourself and your family members. You have an expectation that your insurer will be just as faithful should you need medical treatment.
Unfortunately, too often insurance companies’ biggest concern is their financial bottom line. They use denial and delay tactics, hoping those they insure will eventually give up—and in many cases, this is exactly what happens. Most people believe it is futile to fight big insurance companies. Attorney Scott Glovsky believes those who pay for health insurance should not be taken advantage of in their time of need. Scott has forced many insurers to fulfill their promises to policyholders.
How the Law Offices of Scott Glovsky Can Help Following a Fresno Health Insurance Denial
If you are facing a Fresno health insurance denial, you need a lawyer who will stand by your side every step of the way and who never hesitates to “step into the ring” with an insurer, no matter how large and powerful it is. Attorney Glovsky is ready to force the insurer to reverse its decision if your health insurer has committed insurance bad faith by denying a legitimate claim. While it can feel as though you are insignificant and powerless, once you have a strong legal advocate in your corner, you realize you can take on a large corporation when they are in the wrong.
Just one example of attorney Scott Glovsky’s results is a $14.9 million settlement in Cowart v. Anthem Blue Cross. Anthem was sued for misleading California individual plan members regarding the doctors in its network for Affordable Care Act plans. Anthem agreed to reimburse members who paid more out-of-pocket because they received medical services from an out-of-network professional. If you are facing an insurance denial or your insurer is delaying paying for medical treatment, Scott Glovsky is here for you. Contact the Law Offices of Scott Glovsky today.