Blue Cross and Blue Shield are currently two of the largest providers of health insurance in the state of California. This means that countless individuals trust Blue Cross and Blue Shield to cover their healthcare needs, and most the time, the company does so without a problem. Unfortunately, there are times when Blue Cross and Blue Shield fail to honor their obligations by denying important claims in an effort to save money.
Such actions can mean the difference between life and death for many patients. If your claim was denied, it may be helpful to contact a Los Angeles Blue Shield of California medical necessity denial lawyer. A well-versed insurance attorney can fully examine the facts of your denial to help you determine your options moving forward.
Common Reasons for a Medical Necessity Denial of a Claim
Whenever a claim is denied, it is important to understand that there are legitimate and illegitimate reasons for denials. The following may be legitimate denials:
- An insurer does not receive enough information to properly process a claim
- The services received by the policyholder are not covered by the insurance policy
- The policyholder is asking the company to pay for an experimental treatment or procedure
- The policyholder is asking the company to pay for an unnecessary or cosmetic procedure
These are practical, and most importantly, legal reasons for denying a claim. However, insurance companies sometimes deny coverage for treatments, medical equipment, and services they have agreed to pay for. If there is any question as to whether a denial is legitimate, it may be best to reach out to a Los Angeles Blue Shield of California medical necessity denial lawyer.
When to Take Legal Action in Los Angeles
Insurance providers such as Blue Cross and Blue Shield are expected to act in good faith in providing coverage. A policyholder should not pay a premium only to have a claim for a medically necessary procedure or medication denied for no reason. Depending on the circumstances surrounding the case, policyholders may be able to file a lawsuit against their insurance providers if any of the following is true:
- The claim was denied unfairly or without a logical reason
- The company consulted a doctor who did not treat the patient and used their opinion to deny the claim
- The company ignored important medical information
Insurance companies often maintain their own team of medical professionals and consult these medical professionals when the time to deny or approve claims arrives. This is normal practice, but in reality, a doctor who does not treat a patient and who has an ulterior motive cannot be fully trusted to make a rational decision.
Speak to a Los Angeles Blue Shield of California Medical Necessity Denial Attorney
A Los Angeles Blue Shield of California medical necessity denial lawyer can help. A skilled attorney with a history of fighting against major insurance companies can provide policyholders with the guidance and advice they need to get their claim approved.
Attorneys, much like insurance companies, have an in-depth understanding of the law surrounding insurance coverage and healthcare, and they can help policyholders even the playing field. If you have had your claim for a medically necessary procedure or medication denied for no reason, it is normal to feel powerless and afraid. Fortunately, there are ways to fight back against health insurance companies and their inhumane policies with the help of the right lawyer. Call today to discuss your concerns.
