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Call Us
  • Home
  • About
    • About Our Firm
    • About Scott Glovsky
    • How Our Firm Has Changed Lives
    • How We Operate
  • Practice Areas
        • Health Insurance Denials
          • Insurance Bad Faith
          • Health Insurance Claim Denials
          • Medical Necessity Denials
          • Experimental/Investigational Denials
          • Out-of-Network Denials
          • Insurance Policy Rescission
          • Health Insurance Denials Public Employees
          • Medicare Advantage Health Insurance Denial
          • We Fight All Health Insurance Companies, Including:
            • Aetna Denial
            • Anthem Blue Cross Denial
            • Blue Shield of California Denial
            • Cigna Denial
            • Health Net Denial
            • Kaiser Permanente Denial
            • OSCAR Health Plan Denial
            • Magellan Healthcare Denial
            • Molina Healthcare Denial
            • Regal Medical Group Denial
            • UnitedHealthcare Denial
        • Medications
          • Prescription Denial
          • Gene Therapy
          • Cancer Treatment
            • Proton Radiation Therapy
          • New Cancer Drugs
          • Expensive Drugs
          • Biologic Drugs
          • Cosentyx
          • Dupixent
          • Enbrel
          • Entyvio
          • Euflexxa
          • Harvoni
          • Humira
          • Intravenous Immunoglobulin (IVIG)
          • Ketamine
          • Leqembi™
          • Monovisc
          • Mounjaro
          • Orthovisc
          • Ozempic
          • POLIVY
          • Radicava
          • Remicade
          • Saxenda
          • Synvisc
          • Spinraza
          • SpaceOAR Hydrogel
          • Stelara
          • Wegovy
          • Xeljanz
          • Xifaxan
          • Zolgensma
        • Injuries & Surgeries
          • Spinal Cord Injury
          • Brain Injury
          • Surgery
          • Back Surgery
          • Ablation Surgery
          • Prosthetic Limb
          • Respite Care
          • Pain Treatment
          • Partial Hospitalization
          • Magnetic Resonance Imaging (MRI)
          • Radiofrequency Ablation (RFA)
        • Health Conditions
          • ALS
          • Alzheimer’s Disease and Dementia
          • Autism
          • Autoimmune Disorders
            • Ankylosing Spondylitis
            • Crohn’s Disease
            • Fibromyalgia
            • Lupus
            • Multiple Sclerosis
          • Blood Disorder
          • Cancer
            • Breast Cancer
            • Prostate Cancer
          • Cerebral Palsy
          • COVID-19
          • Counseling
          • Diabetes
          • Eating Disorder
          • Gastrointestinal Disorders
          • Genetic Testing
          • Genomic Testing
          • Heart Condition
          • Hydrocephalus
          • Intensive Outpatient Program
          • Mental Health
            • Anxiety
            • Bipolar Disorder
            • Depression
            • PTSD
          • Migraine
          • Musculoskeletal Treatment
          • Obesity
          • Osteoarthritis
          • Parkinson's Disease
          • Postural Orthostatic Tachycardia Syndrome
          • Residential Treatment Center (RTC)
          • Retinal Disorders
          • Rheumatoid Arthritis
          • Skin Treatment
          • Spinal Muscular Atrophy
          • Substance Use Disorders & Addiction
          • Ulcerative Colitis
        • Personal Injury
          • Accidents
            • Bicycle Accidents
            • Car Accidents
            • Motorcycle Accidents
            • Truck Accidents
          • Traumatic Brain Injury
          • Catastrophic Injury
          • Burn Injury
          • Wrongful Death
          • Premise Liability
          • Slip & Fall
          • Product Liability
          • Nursing Home Abuse
          • Elder Abuse
        • Sexual Abuse
          • Types of Sexual Abuse
          • Child Sexual Abuse
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          • Abuse by a Clergy Member
          • Abuse by Athletic Coaches
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How Insurers Deny Legitimate Health Insurance Claims

Home » Our Blog » How Insurers Deny Legitimate Health Insurance Claims

How Insurers Deny Legitimate Health Insurance Claims

By Scott Glovsky on August 16th, 2018 in Insurance and Healthcare Denials

Health insurance companies often try to make money by paying out as little as possible in claims. In many cases, this leads to the denial of legitimate health insurance claims for procedures covered by the policy, which in turn can lead to prolonged suffering or financial devastation. When insurers deny legitimate health insurance claims, they are often acting in bad faith, so it is important to know how to recognize the common excuses insurers give for denying legitimate health insurance claims.

Common Reasons Given for Denying Legitimate Claims

The Los Angeles Times reports that many insurance denials result from largely trivial bureaucratic issues, and when these denials were challenged by patients, approximately half of them were then covered. The question is: why? Is this a deliberate strategy on the part of insurance companies to see what they can get away with by wearing patients down, often while they are still sick or injured?

The most common reasons an insurer may cite when denying a legitimate claim include:

  • The insured’s policy does not cover the treatment
  • The insured is requesting an experimental or cosmetic treatment
  • A lack of pre-authorization or referral
  • The insurer does not consider the procedure to be medically necessary

Post Claim Underwriting

Although illegal, home, car, or business insurance companies may try another tactic, known as post-claim underwriting. This basically involves searching for any reason to deny a claim, such as a minor mistake in the original insurance application. They then attempt to rescind the policy, leaving the claimant uncovered.

Fighting Insurance Claim Denials

Some denials are relatively easy to fight, such as those stating the doctor used the wrong code. Other reasons for rejection can take a lot of time and effort to overturn. The Wall Street Journal recommends asking an insurance company representative for the documents needed to determine why the claim was rejected, as well as the insurance company’s appeals process. Get a copy of the plan’s Evidence of Coverage, and the guidelines used by the company to decide whether or not a procedure is considered medically necessary. Take notes and get the names of every insurance company representative with whom you speak.

If coverage was rejected under the guise of a procedure being experimental or not medically necessary, patients can have their physician write a letter to the company on their behalf. They can also look for scientific, peer-reviewed articles online that demonstrate the treatment they received benefits patients with their condition.

Contacting an Insurance Denial Attorney

If your health insurer has denied a legitimate medical claim, you may need the services of an experienced insurance attorney. Call today to make an appointment and let a seasoned lawyer review your case and advise you of your options.

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  • Home
  • About
    ▼
    • About Our Firm
    • About Scott Glovsky
    • How Our Firm Has Changed Lives
    • How We Operate
  • Practice Areas
    ▼
    • Health Insurance Denials
      ▼
      • Insurance Bad Faith
      • Health Insurance Claim Denials
      • Medical Necessity Denials
      • Experimental/Investigational Denials
      • Out-of-Network Denials
      • Insurance Policy Rescission
      • Health Insurance Denials Public Employees
      • Medicare Advantage Health Insurance Denial
      • We Fight All Health Insurance Companies, Including:
        ▼
        • Aetna Denial
        • Anthem Blue Cross Denial
        • Blue Shield of California Denial
        • Cigna Denial
        • Health Net Denial
        • Kaiser Permanente Denial
        • OSCAR Health Plan Denial
        • Magellan Healthcare Denial
        • Molina Healthcare Denial
        • Regal Medical Group Denial
        • UnitedHealthcare Denial
    • Medications
      ▼
      • Prescription Denial
      • Gene Therapy
      • Cancer Treatment
        ▼
        • Proton Radiation Therapy
      • New Cancer Drugs
      • Expensive Drugs
      • Biologic Drugs
      • Cosentyx
      • Dupixent
      • Enbrel
      • Entyvio
      • Euflexxa
      • Harvoni
      • Humira
      • Intravenous Immunoglobulin (IVIG)
      • Ketamine
      • Leqembi™
      • Monovisc
      • Mounjaro
      • Orthovisc
      • Ozempic
      • POLIVY
      • Radicava
      • Remicade
      • Saxenda
      • Synvisc
      • Spinraza
      • SpaceOAR Hydrogel
      • Stelara
      • Wegovy
      • Xeljanz
      • Xifaxan
      • Zolgensma
    • Injuries & Surgeries
      ▼
      • Spinal Cord Injury
      • Brain Injury
      • Surgery
      • Back Surgery
      • Ablation Surgery
      • Prosthetic Limb
      • Respite Care
      • Pain Treatment
      • Partial Hospitalization
      • Magnetic Resonance Imaging (MRI)
      • Radiofrequency Ablation (RFA)
    • Health Conditions
      ▼
      • ALS
      • Alzheimer’s Disease and Dementia
      • Autism
      • Autoimmune Disorders
        ▼
        • Ankylosing Spondylitis
        • Crohn’s Disease
        • Fibromyalgia
        • Lupus
        • Multiple Sclerosis
      • Blood Disorder
      • Cancer
        ▼
        • Breast Cancer
        • Prostate Cancer
      • Cerebral Palsy
      • COVID-19
      • Counseling
      • Diabetes
      • Eating Disorder
      • Gastrointestinal Disorders
      • Genetic Testing
      • Genomic Testing
      • Heart Condition
      • Hydrocephalus
      • Intensive Outpatient Program
      • Mental Health
        ▼
        • Anxiety
        • Bipolar Disorder
        • Depression
        • PTSD
      • Migraine
      • Musculoskeletal Treatment
      • Obesity
      • Osteoarthritis
      • Parkinson’s Disease
      • Postural Orthostatic Tachycardia Syndrome
      • Residential Treatment Center (RTC)
      • Retinal Disorders
      • Rheumatoid Arthritis
      • Skin Treatment
      • Spinal Muscular Atrophy
      • Substance Use Disorders & Addiction
      • Ulcerative Colitis
    • Personal Injury
      ▼
      • Accidents
        ▼
        • Bicycle Accidents
        • Car Accidents
        • Motorcycle Accidents
        • Truck Accidents
      • Traumatic Brain Injury
      • Catastrophic Injury
      • Burn Injury
      • Wrongful Death
      • Premise Liability
      • Slip & Fall
      • Product Liability
      • Nursing Home Abuse
      • Elder Abuse
    • Sexual Abuse
      ▼
      • Types of Sexual Abuse
      • Child Sexual Abuse
      • Campus Abuse
      • Special Needs Abuse
      • Abuse at School
      • Abuse at Camp
      • Abuse by a Clergy Member
      • Abuse by Athletic Coaches
    • Business Issues
      ▼
      • Employment & Business Issues
      • Broker & Agent Negligence
      • Business Contingency Litigation
      • Unfair Business Practices
      • Workplace Harassment
      • Wrongful Termination
      • Whistleblower
        ▼
        • Qui-Tam
  • Results
    ▼
    • Testimonials
    • Case Results
  • In The Media
  • Resources
    ▼
    • Frequently Asked Questions
    • Trial Lawyer Talk Podcast
    • Fight Health Insurance Denials Book
    • Download Our eBook
    • Helpful Resources
    • Blog
    • Guides
    • Sign Up for Our Mailing List
    • Power of Resilience Scholarship
  • Contact