It is an unfortunate fact that mental illness and addiction often go hand in hand. According to the Substance Abuse and Mental Health Services Administration, an estimated 7.9 million people experienced a simultaneous mental health condition and substance use disorder, known as a dual diagnosis, in 2014.
When people seek out treatment for their conditions, they expect that they will receive all the care that they need, especially when the state is their primary healthcare provider. Unfortunately, insurance companies can deny claims if they feel that mental health issues are solely caused by substance abuse or if they do not believe that treatment is necessary.
If you are denied care for dual diagnosis treatment, you have legal options that a Los Angeles dual diagnosis denial lawyer can help you explore. A qualified attorney can examine the reasons for your denial and take the appropriate steps to help people obtain the care that they need.
Why an Insurance Company Might Deny Treatment
When an insurance company reviews any claim for care, they determine whether the care is necessary. Insurance companies employ their own doctors who analyze medical records to decide whether any future treatment is needed. However, in the case of substance abuse, some doctors believe that this condition is a moral weakness as opposed to a disease. As a result, these doctors may be hesitant to recommend rehabilitation sessions, especially when coupled with a history of mental illness.
Insurance companies may also deny requests for treatment if a patient does not have a proper referral. Many potential dual diagnosis patients have a spotty history of primary care or are unable to obtain consistent treatment for a mental health condition. In this situation, it can be difficult to obtain a proper referral.
Fighting Back Against A Denial
A strong first step to obtaining treatment after a denial is to examine the denial letter, as this letter must outline the reasons for the denial. A Los Angeles dual diagnosis denial attorney could help people to understand why they were denied and to form a strategy to reverse this denial.
Once a person understands why they were denied, they can take steps to appeal this decision. All California health insurance providers are required by law to provide means to appeal a denial. Typically, an appeal must be filed within 30 days of the denial.
Only once this appeal is submitted and denied can a complaint be filed with the state of California. The Department of Managed Healthcare maintains a procedure to request an independent medical review that will examine all the factors leading to the denial and issue a new decision concerning necessary treatment. An experienced lawyer can help people file the necessary appeals and prepare their cases for an independent review.
Los Angeles Dual Diagnosis Denial Attorney Could Help
An insurance company’s decision to deny vital treatment to a patient can be heartbreaking. Thankfully, California requires all insurance companies to maintain an appeal process to reexamine why treatment was denied. Even if your appeal is unsuccessful, you can still request an independent medical review of your case.
An experienced Los Angeles dual diagnosis denial lawyer can assist you by examining your denial letter, helping you file an appeal with your insurance company, and preparing your case to be sent to the independent review board. Contact our firm today to schedule an appointment to discuss your case.
