Health insurance helps you pay for care in the event of an illness or injury and offers security for you and your family. Unfortunately, there are times with an insurance company may delay, deny, or underpay claims to ensure that they are able to maximize their profits. If you have been subject to insurance bad faith, reach out to an attorney who is knowledgeable about the common examples of insurance bad faith in Los Angeles. An experienced bad faith insurance lawyer can fight for you when you have an issue with your insurance provider.
Circumstances When an Insurance Company May Deny Claims
Health insurance companies in Los Angeles often deny claims based on a declaration that the treatment is:
- Not medically necessary
- Experimental or investigational
- Not covered under the insurance policy
Many times, these statements are false. For example, health insurance companies claim that expensive medical treatments are experimental and/or investigational when they are not. This is especially common with new medical treatments that are expensive.
When the Federal Drug Administration (FDA) approves a new medication, it is usually costly. Health insurance companies delay taking new treatments off their list of experimental and investigational treatments to save money. Once the FDA approves medical treatment, the insurance companies act in bad faith if they still deny treatment claiming it is experimental or investigational.
Further, the insurance company medical reviewers who are often called medical directors are given stringent policies and procedures to follow. If the policies and procedures are outdated and list medical treatments as experimental or investigational when they are FDA-approved, the health insurance companies are acting in bad faith when their agent medical directors wrongly deny expensive treatment on the basis of it still being investigational or experimental.
Why Insurance Companies Deny or Delay Claims
Health insurance companies in California might deny and delay claims to save money and boost their profits. Health insurance companies sometimes deny back surgery claiming it is not medically necessary, experimental, or investigational. Through these denials, the health insurance companies delay medically-necessary treatment and keep the money in their bank accounts while the policyholder experiences tremendous pain. One of the common examples of insurance bad faith in Los Angeles is when a person is forced to wait for a back surgery to treat a herniated disc so the insurance company can make more money.
It is common for health insurance companies to deny laminectomies, discectomies, laminotomies, and foraminotomies while the patients suffer so the insurance companies can buy time and earn interest on their huge profits. With the delays and denials for thousands of medical claims, the health insurance companies boost their short-term profits and maximize the recovery for their shareholders at the expense of people’s health. When someone is denied needed care, they should contact an accomplished attorney right away.
Filing a Lawsuit for Bad Faith in Los Angeles
Insurance companies may act in bad faith for denying various types of medical treatment. Health insurance companies may deny expensive medications unreasonably or without proper cause because they are expensive. Insurance companies also deny artificial limbs claiming they are not medically necessary. They deny technologically-advanced artificial limbs because they are more expensive. With new technology, people who need artificial limbs can make great strides. However, because of the expense, the health insurance companies do not want to pay for the treatment, medication, or medical equipment.
For more information about the common examples of insurance bad faith in Los Angeles, call a well-trained lawyer today.