Millions of older and disabled individuals are enrolled in the Medicare health insurance program. Unfortunately, as with any other type of health insurance, Medicare can deny a claim for a medically necessary procedure. This can be devastating, but enrollees may have legal options available to fight the denial.
By working with a Los Angeles Medicare medical necessity denial (CO50) lawyer, enrollees may be able to obtain the coverage they were initially denied. If you have been denied coverage for a treatment the doctor said you needed, speaking to a knowledgeable insurance denial lawyer can be immensely helpful.
What is Medicare?
Medicare is a government-run health insurance program that allows individuals age 65 and older and individuals with physical and mental disabilities to enroll. The program allows these people to receive health insurance at a much lower cost than the rest of the American population, and enrollees even have the option to enroll in Medicare-approved plans offered by private health insurance companies, such as Blue Cross and Aetna.
Medicare works much like other types of health insurance. Enrollees pay any applicable premiums, deductibles, and copays, and to receive coverage, their medical providers must submit claims for approval.
For the most part, claims for important procedures and prescription drugs are approved. Still, Medicare will occasionally deny coverage for a medically necessary treatment or drug. This can be profoundly upsetting for enrollees, who may be depending on the treatment or drug to help them live a normal life or recover from a serious illness.
What Happens When a Medical Necessity Claim is Denied?
Medicare enrollees are likely to experience a multitude of problems if the government or a private insurance company denies their medical necessity claim. Medical professionals rarely claim a procedure or drug is medically necessary unless the need for the procedure or drug is great.
When a patient does not receive the care they need, they are at a much higher risk of developing additional medical complications and conditions that can make the initial condition more serious. Some patients, in an attempt to obtain the care they need, use their own funds or take out loans to pay medical providers. This can be financially disastrous, especially since medical procedures, even minor ones, can cost hundreds of thousands of dollars.
Fighting a Denial in Los Angeles
Working with a Los Angeles Medicare medical necessity denial (CO50) lawyer may be the only option for enrollees who have had their claims denied by the state government or a private insurer. The criteria insurers use to decide whether a claim should be approved or denied is often questionable, and if an attorney can prove an insurer denied a claim for no logical reason, they may be able to help the person obtain the coverage they need. To do this, an attorney may need to:
- Obtain testimony from other medical professionals
- Review the claims approval process extensively
- Examine the policy to see whether the insurer is contractually obligated to provide coverage
- Submit additional medical evidence the client needs the procedure or drug to survive or live a higher-quality life
Whenever someone is unsure of the reason of a denial, they should reach out to an experienced legal professional who understands insurance companies and how they operate.
Call a Los Angeles Medicare Medical Necessity Denial (CO50) Attorney
Dealing with the government can be difficult and dealing with health insurers can be even more difficult. This is enough to prevent many people from fighting back in the face of a medical necessity claim denial.
Fortunately for enrollees, it may be possible to reverse a decision and receive additional compensation for suffering. Call a Los Angeles Medicare medical necessity denial (CO50) lawyer today to learn more about your options.