Receiving a Fontana health insurance denial can be extremely discouraging. You may have been faithfully paying your monthly insurance premiums for months, years, or even decades. Many people seldom use their health insurance, but when a serious illness or injury strikes, they expect that their insurer will be there for them. If this turns out not to be true, you may have little idea of how to proceed. This is the time when you can benefit from having an experienced Fontana health insurance denial attorney from the Law Offices of Scott Glovsky by your side.
Claim denials are a challenge for the millions of people who depend on their healthcare insurers to do the right thing. Unfortunately, the cost of healthcare premiums and doctors, hospitals, medical tests, and prescription drugs has skyrocketed. Medical debt is now the number one cause of bankruptcy in America. Medical debt can destroy finances, and health insurance denials are a strong contributor to this issue.
It is difficult to know just how many healthcare claims are denied because insurers are not required to provide this information. Some claim the number is one in ten, others say one in four, and some estimates are as high as 40 percent of all claims. Many insurance companies are focused on their financial bottom line and too often may sacrifice the needs of their insured people to increase the company bank account. Do not take these tactics lying down. Attorney Scott Glovsky is ready to help you fight back – and win!
Why Are Health Insurance Claims Denied?
There are many different reasons health insurance claims are denied. For example, the claim may be missing information that can be provided, and then the insurer will pay the claim. This is known as a “soft” denial because it can usually be easily fixed. Other types of soft denials include miscoded claims, missing paperwork, and paperwork errors. Your insurer may deny the treatment until you have gone through step therapy, which means trying less expensive treatments before it will pay for the more doctor-prescribed expensive treatment.
In some cases, the treatment may be specifically excluded in the policy documents, or you may have used an out-of-network provider. In many cases, your insurer will include words like “not medically necessary,” “experimental,” or “investigational” in the denial. These words usually mean that the treatment is expensive, and the insurer does not want to pay. This type of denial must usually be countered through appeals.
What Can You Do if You Receive a Fontana, California Health Insurance Denial?
Whatever you decide to do after receiving a Fontana health insurance denial, it is important that you do it relatively quickly. Insurers have specific time frames from the time of the denial to file an appeal. You can first file an internal appeal, asking your insurer to look at the claim again and approve it.
You might find it advantageous to include a letter from your doctor that details all the reasons you need the treatment. If your claim is still denied, you can file an external appeal. External appeals are filed to a neutral third party, and the decision of that third party is binding on the insurer. If your insurer has denied a legitimate claim, it may have acted in bad faith, and if this is the case, you can sue the insurer.
Which Insurers are Most Likely to Deny Treatments?
Every health insurance company denies claims. Some deny more claims than others, and some deny specific types of claims, while others may deny claims based primarily on cost. The California insurers who could deny a medical treatment include:
When Should You Hire a Fontana Health Insurance Denial Attorney?
You should hire a health insurance denial attorney as soon as possible after receiving a denial. The sooner your attorney can defend your right to a treatment you need, the better. Evidence can be gathered sooner, and you can avoid making certain mistakes that can damage your ability to have the claim paid. If you were unaware that you needed to speak to an attorney soon after your denial, so you have waited longer than is optimal, then hire a health insurance denial attorney when any of the following situations are at hand:
- Your insurer is giving you the “runaround” by ignoring your calls and letters and delaying paying a legitimate claim.
- You received a denial or underpay that you do not believe is legitimate.
- Your insurance policy was terminated for no reason. If you have properly paid your premiums only to find that your insurance was terminated without your knowledge, you need an attorney as quickly as possible.
How the Law Offices of Scott Glovsky Can Help Following a Fontana Health Insurance Denial
Attorney Scott Glovsky and his legal team have fought cases that have impacted millions of policyholders. We have forced insurers to change their behavior.
For example, our firm exposed Aetna not reviewing medical records before denying treatment. Our firm forced Kaiser to stop systematically denying Applied Behavioral Analysis and speech therapy to children with autism spectrum disorders.
More of our successes and testimonials can be found on our website. We understand how difficult it can be to have a treatment denied by your insurer and how such a denial can impact your health and your future. Do not wait – contact the Law Offices of Scott Glovsky today.