Kaiser Permanente is one of the largest health insurance providers in the country, and their presence is especially significant in California. For the most part, Kaiser and other health insurance providers do not have a problem providing coverage to policyholders. Unfortunately, there have been times when Kaiser denied coverage to policyholders for medically necessary treatments and medications, placing the lives of those policyholders at risk.
If an insurance company fails to live up to its promises, there are ways for individuals who had their claims denied to seek justice with a health insurance denial attorney’s help. By working with a Los Angeles Kaiser Permanente medical necessity denial lawyer, it may be possible for you to get a claim that was initially denied approved. Speak with a medical necessity denial attorney today.
Why Would an Insurer Deny Coverage for a Medically Necessary Treatment?
A health insurance company has the right to deny a claim for a treatment or medication if it does not believe the treatment or medication is “medically necessary.” This simply means they can deny coverage if they believe the policyholder can live a healthy life without treatment or medication, or if they believe a cheaper, equally effective alternative is available.
Sometimes, however, they may do this even when the physician of a policyholder states that the treatment is necessary. Insurance companies often hire their own physicians to consult when making decisions about claims, and these doctors often have a vested interest in the company’s economic welfare rather than the needs of a patient they have never treated.
HMOs and Utilization Management
Although POS and PPO policies have become more common in recent times, many California residents are still enrolled in Health Maintenance Organizations (HMOs). These health insurance plans are notorious for denying coverage for medically necessary procedures and medications, but they are still popular.
HMOs employ a system called “utilization management” when deciding whether to approve or deny a claim. When this system is employed, a team of physicians and other medical professionals decide if the treatment or medication in question is medically necessary.
Unfortunately, as previously mentioned, these individuals are often more concerned with cutting costs than the well-being of patients, and they often deny coverage for certain procedures in an effort to boost revenue and lower operating expenses. Even the medical professionals they employ are encouraged to participate in this culture of “cost-cutting.”
Importance of Legal Assistance
Many health insurance consumers feel powerless and confused in the wake of a claim denial. This is understandable, but consumers should know they may have legal options at their disposal. A Los Angeles Kaiser Permanente medical necessity denial lawyer may be able to assist health care consumers by:
- Helping them formally file a lawsuit
- Investigating the process the insurer uses to deny or approve claims
- Obtaining testimony from additional medical professionals
- Working to hold the insurer responsible for any negative outcome caused by the denial
If the denial of the initial claim caused the policyholder to sustain any physical, emotional, or financial damages, an attorney may be able to hold the insurer liable monetarily and legally.
Consulting a Los Angeles Kaiser Permanente Medical Necessity Denial Attorney
It is often unfair for insurance companies to deny coverage for medications and procedures deemed medically necessary, as such treatments may have the potential to save lives and drastically improve the health of patients. Get in touch with a Los Angeles Kaiser Permanente medical necessity denial lawyer today to learn more about taking legal action against an insurer who denies such a claim in your case.
