Health insurance is necessary, and each day, millions of Americans rely on insurance companies to cover their healthcare needs. For the most part, health insurance companies are willing to provide the coverage they agree to provide, but sometimes they will deny a claim for no reasons. This is unfair to policyholders, who pay a premium to ensure they are covered in the event of a medical emergency.
If you or someone you care about has been denied coverage for an illness or injury, even though a physician has stated your treatment is medically necessary, it may be beneficial to work with a Los Angeles Healthnet medical necessity denial lawyer. A practiced insurance denial attorney can help determine a plan to get the coverage you need.
Fighting Back Against a Healthnet Denial
After having their claim denied for a medically necessary treatment or medication, many people feel a deep sense of despair and anger. Such feelings are normal, but it is important for policyholders to remember they may be able to fight back with the help of a Los Angeles Healthnet medical necessity denial lawyer.
The insurance company does not always have the last word, and if an insurer chooses to deny a claim for no logical reason, they should be held accountable for their actions. Depending on the nature of the case, an attorney may be able to help policyholders do the following:
- Carry out an in-depth investigation of the process and criteria an insurer uses to approve or deny a claim
- Thoroughly examine the details contained in the coverage policy
- Retain the services of other insurance professionals and physicians
- Hold the insurer responsible for any damages incurred by the policyholder
Often, when a claim is denied for no reason, the policyholder is left with a barrage of emotional scars and medical bills. In many cases, they may have to use their own funds to cover additional expenses. A skilled lawyer can help them recover these damages.
Medical Necessity Denials in Los Angeles
When a physician or medical professional deems a treatment “medically necessary,” the policyholder should submit a claim for treatment to the insurance company. If their insurance company offers coverage for the treatment, they should approve the claim.
Unfortunately, this does not always happen and insurance companies may attempt to refuse coverage for a treatment or medication they are contractually obligated to cover. Insurers often consult a team of their own doctors who will not have the opportunity to examine the patient themselves before denying a claim.
Sometimes, even when a claim is approved, the insurance company will only agree to cover a cheaper, often less effective, alternative. This is unfair, and when a person cannot receive the medical care they need there is a risk of death or further injury.
The Price of Cutting Costs
Many people forget insurance companies are businesses. Even though they provide an essential service to society, their ultimate goal is to generate profits and reduce operational costs. To do this, they may attempt to curb costs by denying certain policyholder claims.
Despite the consequences of such behavior, insurance companies are often willing to jeopardize the health of their policyholders and their own reputation to avoid paying for expensive treatments and medications. However, a Los Angeles Healthnet medical necessity denial lawyer can work to hold them accountable.
Call a Los Angeles Healthnet Medical Necessity Denial Attorney
Insurance companies can be remarkably difficult to deal with, especially when you do not know what steps to take. Fortunately, a skilled attorney can work to help you obtain the coverage you need to reclaim your health and move forward with your life. Call a Los Angeles Healthnet medical necessity denial lawyer today to get started.