An eating disorder can have a profound impact on a person’s life. Not only do those suffering from eating disorders risk dangerous weight fluctuations, but the lack of vital nutrients and vitamins stemming from an improper diet can lead to serious infections and diseases.
Eating disorders are a manageable mental health concern when properly treated. However, health insurance companies in Los Angeles will often deny treatment for eating disorders, and patients may be forced to pay for treatment out of pocket or to forego treatment altogether.
Fortunately, these patients have options to appeal denials of claims. If you experienced a Los Angeles eating disorder treatment denial, a seasoned attorney can help you identify the reasons why and assist you in moving forward.
Justifications for Treatment Denials
Many insurance companies exist primarily for the purpose of turning a profit. If they can find any reason to deny a specific treatment, or to even rescind coverage entirely, they may do so. Common reasons for companies to deny treatment include:
- The patient’s failure to obtain a proper referral for eating disorder treatment
- Rescission of a policy by the insurance company because of errors made during the application process
- The insurance company’s medical review team not believing that treatment is necessary
Any of these reasons for a denial can be grounds for an appeal, and some are even outright illegal. Whenever an insurance company in California issues a denial of coverage for an eating disorder, the law requires them to issue a letter outlining the reasons for the denial. Speaking with an experienced attorney could provide rejected policyholders with a detailed explanation concerning the reasons their treatment was denied.
Appealing a Denial of Treatment for an Eating Disorder
California law requires that all health insurance companies maintain an internal appeal procedure for Los Angeles eating disorder treatment denial. This procedure must give claimants at least 30 days to appeal a denial. Unfortunately, these appeals are rarely successful, as the same people who initially denied the claim are often responsible for reexamining the file.
In light of this, the first real opportunity to make an impact may be filing an appeal with the Department of Managed Healthcare. This department is mandated to review any denial of medical treatment for any reason and employs an independent board of doctors to analyze the claimant’s reasons for requesting treatment and the insurance company’s rationale for a denial. This board then issues an opinion as to whether the treatment should be provided.
Even if this appeal is not successful, the claimant has the option to subsequently file a lawsuit in court. This lawsuit may allege that the insurance company breached their contract with the claimant when they denied coverage. In addition to the court potentially ordering payments for the treatment, a favorable verdict may also award monetary damages to compensate the claimant for any bad faith exhibited by the insurance company. For more information about California insurance law, call a well-trained attorney.
Do Not Give Up After a Treatment Denial
Whenever an insurance company in Los Angeles issues a denial for treatment, they must explain why. These companies are also required under California law to maintain an internal appeal process to reconcile customer complaints, although these appeals are rarely successful.
If you are denied coverage for an eating disorder, you may find speaking with a lawyer beneficial. A qualified attorney can help you understand why you were denied coverage, explain potential next steps, and help you pursue an appropriate remedy.
The time to appeal a Los Angeles eating disorder treatment denial is always short. Especially in situations where obtaining care is of critical importance, time is of the essence, so get in touch with a dedicated lawyer today to get started on your case.