Whether your back issues are the result of a catastrophic accident, the culmination of a lifetime of manual labor, or the result of years of steadily weakening joints or ligaments, it is vital to receive the care necessary to make your life more comfortable. Unfortunately, the back surgery that may be necessary to improve these conditions can be very expensive. Many people are subscribers of health insurance plans that are supposed to provide payments to doctors and hospitals for these treatments. However, getting the insurance companies to approve these procedures can be difficult. A Los Angeles back surgery denial lawyer can help you obtain the care you need to improve the quality of your life. A vigilant health insurance denial attorney could demand that insurance companies honor their agreements and file necessary appeals and lawsuits to get you the care you need.
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Why Would an Insurance Company Deny a Back Surgery?
Health insurance operates on the premise that the insurance company will pay for any medically necessary treatment that is likely to improve a person’s quality of life. However, insurance companies do not always believe back surgery is a necessary treatment since many procedures are not guaranteed to result in success. Issues such as sciatica, bulging disks, or back fractures can continue to impact a person’s life even after a successful procedure. Because of this, policyholders may need to appeal the denial by demonstrating that their doctors give their condition a solid chance of improvement.
Insurance companies may also deny a claim based upon a perceived lack of truthfulness of their subscribers. Whenever someone applies for health insurance coverage, they are required by law to provide accurate information concerning their current health. If the insurance company believes that the insured did not disclose a prior back condition when applying for the plan, the insurer may deny payment for that condition or rescind the policy entirely.
Options for Appealing Denied Back Surgery Claims
The most direct way to seek enforcement of a policy may be to file an appeal with the insurance company. Under California law, all companies are required to maintain an internal appeals process to handle client disputes. Insurance companies must give policyholders at least 30 days after the receipt of a denial letter to file the appeal.
If this appeal fails to resolve the issue, the individual may either take their case to the State or initiate a civil lawsuit depending on the circumstances. The State handles all matters of health insurance claims disputes through the Department of Managed Healthcare (DMHC). The DMHC is an agency that employs an independent board of doctors who examine health insurance denials and issue rulings determining whether the insurance company should pay for the proposed treatment.
If a person chooses to file an appeal with the DMHC and receives an unfavorable decision, they may still take their case to court. Insurance policies are a contract between the insurance company and the insured. If the insurance company refuses to honor its end of the bargain by not paying for covered treatment, the subscriber may be able to ask that the court enforce the contract. A Los Angeles back surgery denial lawyer could help an individual file an appeal for a denied claim.
How a Los Angeles Back Surgery Denial Attorney Can Be an Advocate
A successful back surgery can relieve years of pain and give people a new lease on life. However, these procedures can be very expensive and health insurance companies may hesitate to pay for them, claiming that it is a luxury that has no medical necessity. Health insurers may also attempt to argue that the procedure is not guaranteed to fix the core problem.
A Los Angeles back surgery denial lawyer can help. An attorney with years of experience in filing appeals with both insurance companies and the State demanding enforcement of insurance policies can fight for you to receive the coverage you may be entitled to. Call today to discuss your case.
The Law Offices of Scott Glovsky
The Law Offices of Scott Glovsky focuses on health insurance law. We have represented injured consumers and victims of wrongful business practices for more than the past two decades. Scott Glovsky is recognized as one California’s most experienced, compassionate, and trusted insurance law attorneys.
