Eating Disorder Health Claim Denials
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.
Eating Disorder Health Claim Denial Lawyer
Serving Los Angeles, Claremont, and Pasadena
Our eating disorder cases have deeply impacted our legal practice. Eating disorders, such as anorexia nervosa and bulimia nervosa, are very serious diseases. The disease prevents sufferers from leading healthy emotional, social, and spiritual lives. Eating disorders can often become chronic, debilitating, and life-threatening. To battle this debilitating disease, it is critical that the sufferer get help.
Yet many insurance companies deny and delay critical services and treatments. The results can be deadly. In instances where those suffering from an eating disorder were injured due to the negligence of an insurance provider, seek the assistance of a Los Angeles County eating disorder lawyer to build a claim and fight for any damages that you may be entitled to. To discuss your case or learn more about what options may be available, consult with an injury attorney in LA County today.
Eating Disorder Statistics
- Eating disorders have the highest mortality rate of any mental illness
- Anorexia is the third most common chronic illness among adolescents
- Almost 50% of people with eating disorders meet the criteria for depression
- Up to 24 million people of all ages and genders suffer from an eating disorder (anorexia, bulimia, and binge eating disorder)
Getting Treatment for Eating Disorders
The precise cause of eating disorders is not entirely understood. Causes are believed to be based on biological, psychological, and/or environmental abnormalities. Whatever the cause, it’s clear that sufferers need help. Experts believe early diagnosis and intervention help enhance recovery.
Health insurance companies are obligated to provide a variety of health services to sufferers. This may include one or more of the following, which if not provided should warrant contact with a Pasadena eating disorder attorney:
- Residential treatment
- Inpatient hospitalization
- Outpatient treatment
- Individual or group therapy
- Peer support groups
- Eating disorder education
- Nutritional counseling
- Medical monitoring
- Family therapy
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 it to issue a letter outlining the reasons for the denial. Speaking with an experienced attorney could help 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. Before going to the Department of Managed Healthcare, we recommend you speak with a qualified health insurance attorney. The reason for this is that your options may be limited after a decision, so it is best to get advice on how to proceed beforehand.
Even if this appeal is unsuccessful, the claimant can file a lawsuit in court subsequently. This lawsuit may allege that the insurance company breached its contract with the claimant when it 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, it 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 often unsuccessful.
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.
Seeking Justice Following an Eating Disorder
If you’ve lost a loved one because of this terrible illness and a health insurer (or insurance company) denied treatment, our Los Angeles, Claremont, and Pasadena eating disorder lawyers may be able to seek justice for your loss. Nothing can bring back your child, but bringing a suit against the organization that caused or contributed to the loss of your child is a way to send a message to this organization to never deny these medically necessary services to a suffering child.
In addition, large settlements and verdicts send a strong economic message to insurance companies that deny critical services to individuals with eating disorders. Million-dollar judgments encourage insurance companies to change and replace bad policies with good ones. These judgments also support good doctors in insurance companies who advocate for patients despite the additional costs and negative impact on insurance company profits.
If your health insurance company refuses to pay for your or a loved one’s eating disorder treatment, please contact the Law Offices of Scott Glovsky. This is a very serious illness that demands immediate attention.
Hiring a Los Angeles County Eating Disorder Attorney
Scott Glovsky is nationally recognized as an eating disorder lawyer. He brought national attention to the fight against insurance companies for denying care for eating disorder patients in the case of Janell Smith. The case was featured on major networks including CNN and CBS. Mr. Glovsky appeared live with Janell’s parents on The Early Show from New York City. Click here to learn about the story.
If your health insurer has denied treatment related to an eating disorder or payment for such treatment, we can help. We have substantial experience fighting insurance companies that have denied coverage for eating disorders.