Millions of hardworking men and women in California trust Aetna to handle their health insurance needs. Unfortunately, Aetna has denied coverage to many policyholders for medically necessary treatments and prescription drugs.
If your Aetna health insurance claim for a medically necessary treatment or drug was denied, an adept attorney could help you obtain financial compensation for your ordeal and any healthcare costs you may have incurred. Speak with a Los Angeles Aetna health insurance medical necessity denial lawyer if you believe your claim for a critical treatment or drug was unfairly rejected.
Why Does Aetna Deny Claims?
Medical procedures such as surgeries can cost thousands of dollars. More expensive surgeries—particularly those that treat the brain, heart, and spinal cord—can cost hundreds of thousands of dollars.
To protect themselves from such astronomical costs, the vast majority of Americans enroll in health insurance plans. The type of coverage a policyholder receives depends on the plan they enroll in, but in general, most people expect their insurer to cover the treatments they agreed to cover.
Unfortunately, this does not always happen, and insurance companies do have a right to deny coverage of medically necessary treatments for life-threatening illnesses and conditions. Sometimes insurers deny coverage if their own team of doctors view a treatment as useless, but often claims are denied simply in an attempt to increase revenue and lower operational costs.
Prescription Drug Coverage
Prescription drugs can be significantly expensive, even with health insurance coverage. Some such drugs can be purchased at relatively low prices, but others can cost tens of thousands of dollars each year. Unfortunately, more expensive drugs tend to have the most important functions, and many people depend on them to live a life that is free of pain and suffering.
Insurance companies are notorious for denying coverage for medical treatments and procedures, but they may also refuse to cover prescription drugs. Even if a prescription drug is deemed a “medical necessity” by a healthcare professional, insurance companies do have a right to deny coverage if they feel a cheaper, equally effective drug can perform the same function.
This is not in the best interest of the policyholder, and if an insurer refuses to cover a drug they are contractually obligated to cover, there may be a way to hold them accountable legally. A health insurance medical necessity denial lawyer in Los Angeles could help Aetna policyholders determine their legal options after a claim denial.
What Happens if an Appeal is Denied?
Most insurance companies in the United States, including Aetna, allow policyholders to file an appeal if they do not agree with a claims decision. The appeals process can be arduous, and insurers often arrive at the same decision a second time even if the policyholder submits additional information.
This can be incredibly frustrating for policyholders, and many choose to simply give up after their initial claim and appeals are denied without a rational explanation. Fortunately for policyholders, a Los Angeles Aetna health insurance medical necessity denial lawyer may be able to help individuals who have had their claims denied for frivolous or trivial reasons continue to seek compensation via alternate means.
How a Los Angeles Aetna Health Insurance Medical Necessity Denial Attorney Could Help
If your medical necessity claim was denied by Aetna, you have every right to feel angry and confused. Insurance companies can be hard to understand, and when they deny coverage for a treatment or drug you need, the prospect of fighting back may seem absurd.
However, by working with an experienced attorney, you may be able to reverse the decision of the insurer. Call a Los Angeles Aetna health insurance medical necessity denial lawyer today to see what may be possible in your case.
