There are few things more disheartening than having a medical issue that requires treatment and then having your health insurance company deny that treatment. You have paid your insurance premiums faithfully, and when you need your insurer to pay for necessary treatment, you receive a Fremont, California health insurance denial. It is difficult to know exactly what percent of health insurance claims are denied, since carriers are not required to report these numbers.
Some industry reports show claim denials range from 17 percent to 30 percent, or even more, depending on the insurance company. Few patients appeal denials because they do not believe they can win against a large corporation. One report found that fewer than 1 percent 1 percent of patients who get their insurance through the Affordable Care Act appealed a claim denial, yet as many as 40 percent of appeals are ultimately successful.
Many of us rarely use our health insurance. We may go for months, even years, without filing a single claim. Then a serious injury or illness strikes, and we assume our health insurer will hold up its end of the bargain – and pay for the treatment. It can be shocking to find out that the claim was denied out of hand. If you are facing a Fremont health insurance claim denial, attorney Scott Glovsky can help. This is what Scott Glovsky and his legal team do every single day – they fight for those who need a strong legal advocate – and they win.
Why Are Health Insurance Claims Denied?
There are numerous reasons a health insurance claim may be denied. When the claim was submitted, it may have been miscoded, which is fairly common. Other issues related to paperwork may also be present and can be fixed. For example, information could be missing, or supporting documentation may not have been included.
The claim could have been denied because of a missed deadline, because you used an out-of-network provider, or because the treatment is specifically excluded from your policy. You should have received a letter from your insurer denying your claim. If there is language in the letter that includes “not medically necessary,” “experimental,” or “investigational,” the issue is oftentimes more likely to be cost.
Some insurers require you to go through “step therapy” when your doctor has prescribed an expensive procedure, treatment, or prescription drug. This means you must start with less expensive treatments and step up from one to the next to see if a less expensive treatment will work. Often known as “Fail First,” this can be frustrating and time-consuming, but it may be necessary to get your insurer to pay for the treatment your doctor believes you need.
What Can You Do if You Receive a Fremont, California Health Insurance Denial?
If you receive a Fremont health insurance denial, it is important that you not give up and simply accept the denial. You have rights, and you have options. You can file an internal appeal that asks your insurer to take a second look at the claim it denied. Including a letter from your doctor detailing why the treatment is necessary for your health can be helpful. You can file an external claim with a neutral third party if your claim is still denied.
The outcome of an external appeal is binding on your insurer. If your insurance company is acting in bad faith, you can file a lawsuit to force the company to pay for a treatment your policy says is covered and oftentimes sue for damages. Check your policy carefully before you start the appeal process. Having an experienced Fremont Health Insurance Denial attorney by your side can also be extremely beneficial. While it is certainly not fair or right, most big insurance companies treat you with more respect when you have a strong attorney by your side who has scores of successes to his or her credit.
Which Insurers are Most Likely to Deny Treatments?
Any health insurance company can deny claims. Many of these insurers have a policy that requires claims adjusters to deny certain covered claims out of hand – perhaps likely because they know very few people will fight back. Do not let your insurer get away with denying a legitimate claim for a treatment you need. Some of the insurers in California who may deny a health care claim include:
What Types of Health Insurance Claims Are Often Denied?
In many cases, a denied health insurance claim is for a treatment that could potentially be lifesaving—and is probably also expensive. Treatments like proton beam therapy can be much more effective than other types of cancer treatments, but they are often denied because they cost more.
An insurance company may label a treatment as investigational or experimental even though it has FDA approval and has been proven to work. Virtually any treatment that stems from newer technology – and is expensive – has a good chance of being denied. A life-saving treatment that has been denied requires all the evidence you can obtain to show that the treatment is, in fact, a medical necessity.
How the Law Offices of Scott Glovsky Can Help Following a Fremont Health Insurance Denial
If you or a loved one has received a Fremont health insurance claim denial, Attorney Scott Glovsky is ready to help you take on the insurer and force it to do what it promised. Out of law school, Scott initially worked for large corporations until he realized that it was his destiny to help individuals who were facing the impossible task of fighting a huge corporation.
Scott Glovsky and his legal team fight for people like you every day, working hard to provide justice to those who think they will never see it. The Law Offices of Scott Glovsky has many, many successes and testimonials to show you what we achieve on a regular basis. Contact the Law Offices of Scott Glovsky today.