Bakersfield Health Insurance Denial Attorney
Although Bakersfield is considered a good place to live due to its high quality of life, residents have the same issues with health insurance denials as those across the United States. When facing a health insurance denial that could have a significant impact on your quality of life and future, having a strong advocate like attorney Scott Glovsky on your side can make all the difference.
What Are the Reasons Your Health Insurance Claim Could Be Denied?
According to Healthcare Finance, hospital claim denial rates have hit new highs post-pandemic, with a 20 percent increase in these denial rates over the past five years. A full one-third of all hospital executives report average claims denial rates of 10 percent or more, while nationally, hospitals are looking at denial rates between 6 percent and 13 percent—officially the “danger zone.”
A 2017 analysis found that out of $3 trillion in medical claims, about 9 percent of those claims were initially denied. In 2021, UnitedHealthcare re-examined its policy regarding ER claims, making it easier for insurers to retroactively deny claims. Significant consumer backlash reversed this decision—but only temporarily.
Your claim may be denied for a relatively simple—and easy to correct—reason such as missing or incorrect data, coding errors, incomplete paperwork, or patient eligibility issues, many insurers deny claims based on the following:
- Out-of-network healthcare provider
- The procedure is not medically necessary
- Failure to obtain prior authorization
- Excluded service
- Experimental treatment or medication
- Site of service exclusions
- Above usual and customary charges
- Inaccurate enrollment files
- A diagnosis of sepsis, malnutrition, or another treatment with conflicting clinical protocols
- Observations status or short stay denials
What Should You Do if Your Health Claim is Denied?
If your healthcare claim is denied, you have the right to ask your insurer to conduct a full and fair review of the denial decision. Within 30 days of receiving your denial letter, you must review the letter to determine why your claim was denied, collect information that relates to why you believe the denial was wrong, contact your healthcare provider to ask for an appeal letter, then submit the appeal request and accompanying paperwork. If your case is urgent (waiting 30 days would seriously jeopardize your health, life, or ability to regain function), you can ask your insurer for an expedited internal appeal.
Follow up until you’ve received a decision, keeping a good record of each time you speak to someone from your insurance company, including the date, name of the person, and what was discussed. This internal review should result in a decision within 30 days if you are requesting prior authorization, or within 60 days if you are requesting reimbursement for a medical service you’ve already received. If your case is urgent and is being expedited, you should receive a decision within 72 hours.
If the response is negative, you can then apply for an independent medical review, also known as an external review. If your insurer denies your coverage after the independent medical review, you can file a complaint with the Department of Managed Healthcare (DMHC). If the decision is still unfavorable, you can file a complaint, and, potentially, a lawsuit against your insurer. Your health insurance denial attorney can assist you through each of these steps and can help you file a lawsuit against your insurer, when necessary.
Which Insurance Companies are Known to Deny Treatments?
Although any insurance company can deny treatment or medication, some insurers are more likely to deny claims than others. Californians may have one of the following insurers who have denied their health insurance claim:
Can I Sue My Insurer for Denying My Claim?
If your appeals are unsuccessful and your insurer is operating in bad faith by denying your healthcare claim, you may be able to sue your insurance company. When an insurance company breaches its promise, failing to honor its contract, you have the right to file a lawsuit to make your insurer do what it promised. A lawsuit against an insurance company may include a cause of action for breach of the duty of good faith and fair dealing—insurance bad faith. This is a very complex area of the law that can always benefit from the services of a Bakersfield health insurance denial attorney from the Law Offices of Scott Glovsky.
How Can an Attorney Help Me Following a Claim Denial?
You may think you can handle your appeal on your own, and, technically, you probably could. If you are like most of us, however, you are short on time, and when facing the appeal process, you may feel overwhelmed. You may even give up on the process because it just feels like too much at a time when you are not feeling your best. Your health insurance denial attorney from the Law Offices of Scott Glovsky will work hard on your behalf to ensure you get the medical treatment you need and deserve in a timely manner.
How Bakersfield Health Insurance Denial Attorney Scott Glovsky Can Help
Having a knowledgeable health insurance denial attorney from the Law Offices of Scott Glovsky gives you a strong advocate who will fight zealously on your behalf. Attorney Scott Glovsky has been helping people just like you for more than two decades. He believes strongly that those who purchase insurance and faithfully pay their premiums deserve better than a company that acts in bad faith. Don’t wait—contact the Law Offices of Scott Glovsky today.
