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Attorney to Help with Covered California Insurance Denials
Welcome Covered California Insurance Purchasers
The Law Offices of Scott Glovsky has helped thousands of families get the healthcare treatments and procedures they deserve. If you purchased your insurance through the Covered California marketplace, you have more rights than most employees in California.
Los Angeles Covered California Health Insurance Denial Lawyer
California laws require health insurance providers to provide minimum policy benefits. Under the Patient Protection and Affordable Care Act (commonly referred to as “Obamacare”), these basic minimum benefits are called “essential health benefits.” Our cases have involved health insurers failing to pay for critical treatments or procedures involving:
- Organ transplants
- Cancer treatments
- Traumatic brain injuries
- Catastrophic injuries
- Psychiatric care
- Behavioral therapies
- Many others
Often, the necessary treatments and procedures may involve out of network health providers, experimental treatments or procedures, and treatments and procedures that the health insurance provider wants someone else to provide. Some of these denials and delays have led to permanent disabilities and even death. In every case, the patient and his or her family has suffered needlessly because of the insurance company’s desire to put profits ahead of people.
Help with Covered California Insurance Denials
Covered California is a free service that connects Californians with brand-name health insurance under the Patient Protection and Affordable Care Act. At Covered California, you can get financial help when you purchase health insurance from well-known companies. This means when you apply for coverage, you could be entitled to a discount on your health plan premiums through Covered California—or could be able to obtain health insurance through the state’s Medi-Cal program. Covered California insurance denials can cause significant health and financial repercussions in your life.
Covered California insurance denials—or worse, cancellations of your insurance—can result in necessary treatments being denied even though you have faithfully held up your end of the bargain by paying your monthly medical premiums. You have the right to expect your plan will protect you when you’ve been injured or need medical care, yet in many cases, you might be denied coverage you are legally entitled to.
If your Covered California health insurance plan provides coverage for a medical expense you’ve incurred, but your provider denies coverage, you may have options. In the same vein, if your insurance was cancelled, you also have options. Despite a health insurance company acting in bad faith, speaking to an experienced insurance claims denial attorney like Scott Glovsky can stop your feelings of powerlessness. When your doctor says you need a test, procedure, or medication, unless specifically excluded, your insurance company should pay. When you have faithfully paid your insurance premiums, being cancelled can be devastating. Either way, Scott Glovsky is ready to help.
At the Law Offices of Scott Glovsky, we fight for our clients. We routinely expose insurance companies that are not holding up their end of the bargain. While many times we can persuade the insurance company to pay for a legitimate health expense without litigation, we are never afraid to go to court on your behalf. With offices in Claremont and Pasadena, we help those in LA County, and across the state of California.
Are You the Victim of Covered California Insurance Denials or Cancellations?
Suppose your doctor ordered a medical test that he or she considered vital to your health, and you suddenly find your insurance through Covered California has been cancelled. Even though you have paid all your premiums in a timely manner, you find you’ve been dropped, with no explanation. Unfortunately, this happens more often than you might think. In other cases, individuals have been shifted into Medi-Cal without their knowledge or consent.
Even worse, in many cases, neither the provider nor Covered California may be able to explain exactly why an individual was terminated. According to a 2016 Sacramento Bee article, the evidence of these unexplained terminations is anecdotal, with not even Covered California knowing how many people have been affected by cancellations. It is also unclear whether the errors resulting in termination are Covered California errors or those of the provider—or both.
As far as Covered California insurance denials, there are several reasons your claim might have been denied, including the following:
- Discrepancies in paperwork, or lack of necessary paperwork;
- Provider failed to submit coverage request in a timely manner;
- Prior authorization was required but not obtained;
- The procedure isn’t covered under the policy;
- An out-of-network provider was used, or
- The procedure is not medically necessary.
It is important to recognize that even if one of the above issues is the stated reason for the denial of service, you may still be able to convince your provider to pay. The provider may initially claim the procedure is not medically necessary, even though your doctor obviously believes it is. Your attorney can fight a decision like that to help you get the treatments your doctor believes are necessary for your health.
You may have used an out-of-network provider out of necessity because there was no in-network provider in your area. Again, your attorney can fight such an arbitrary decision on the part of your provider. All too often, none of the reasons listed above are the cause of your insurance denial, rather the provider is simply attempting to save money. No matter your situation, it can be extremely beneficial to speak to attorney Scott Glovsky regarding an insurance cancellation or denial of service.
Can You Sue Your Insurance Company if You Purchased Insurance Through Covered California?
If you’ve ruled out legitimate issues for your insurance being cancelled or denied, like non-payment of premiums, it is possible your insurance company acted in bad faith. When you signed up for insurance through Covered California, you essentially entered into a contract with your insurance company: you agreed to pay your premiums, and the insurance company agreed to pay your legitimate claims and continue to cover you.
If you’ve held up your end of the bargain, but your insurer failed to do so, a court could find the insurer or Covered California acted in bad faith. When you suspect bad faith is at hand, you do not have to accept a cancellation or insurance denial. You have the right to appeal a denial, and, under certain circumstances, you may file a lawsuit directly against your insurance provider or Covered California for compensation.
When bad faith tactics are at hand, attorney Scott Glovsky can help. Bad faith tactics either explicitly violate California law or violate the implied promise of good faith and fair dealing present between you, the policyholder, and your insurance provider. You may be able to recover the coverage amounts owed, compensation for damages resulting from delays, cancellations, or failure to pay, and additional statutory damages.
Scott Glovsky Helps People Who Purchased Health Insurance through Covered California Fight Covered California Insurance Denials
Covered California could conceivably rescind your coverage entirely when you file a claim. Your insurer can pay your claim, deny your claim, or cancel your policy. Cancellation would leave you with no healthcare coverage, however, if bad faith can be shown, you could be owed a significant settlement. Have you been denied a treatment or procedure?
The Law Offices of Scott Glovsky can help. We never hesitate to go up against a big insurance company on your behalf. You can learn more by exploring our site, or simply give us a call at (626) 243-5598. You can also complete the online form or send us an inquiry form by clicking here. The consultation is free. We want to help — contact the Law Offices of Scott Glovsky today.
