United Healthcare is currently the largest health insurance company in the United States, offering a wide variety of health, dental, life, and vision insurance policies to millions of individuals across the country. Like most health insurance companies, though, United Healthcare occasionally denies claims submitted by policyholders, even when they pertain to medically necessary treatments.
While this is a somewhat normal practice in the insurance industry, it is often not fair. Fortunately, though, there may be a way for policyholders to get the coverage they need, even after an initial denial. If your claim for a medically necessary treatment was denied by United Healthcare, you may want to speak with a Los Angeles United Healthcare medical necessity denial lawyer about your options. An adept medical necessity attorney could help you determine what your next steps should be.
Can Insurance Companies Deny Coverage for Medically Necessary Treatments?
From a business and legal perspective, insurance companies are allowed to deny coverage for certain treatments and medications, even though policyholders pay them a premium each month. Many insurers deny coverage for preexisting conditions, but with new health insurance laws in place, this practice is becoming far less common.
However, health insurance companies can still deny coverage for a treatment or medication if they determine a cheaper, effective alternative is available to a policyholder. This is often done to save money, but when a doctor states a treatment or medication is medically necessary, they usually do not mean a cheaper alternative. By denying coverage for medically necessary treatments, insurance companies can place the health of their policyholders in grave jeopardy.
Understanding the Claims Process
Most people automatically assume a procedure will be covered if it is deemed a medical necessity by a healthcare professional. This is a common presumption, but unfortunately, it is not always true—insurance companies can and do deny coverage for medically necessary treatments.
Even though policyholders must submit claims for coverage with the input of a medical professional, insurance companies usually hire their own team of physicians and nurses to help them decide whether to approve or deny a claim. Unfortunately, these individuals never actually come in contact with the policyholders they are tasked with evaluating, and often they are encouraged—implicitly and explicitly—to keep cost in mind when deciding whether a patient needs a treatment or medication.
How a Lawyer Could Help
As mentioned above, it may be possible for policyholders to fight back against insurance companies with help from a Los Angeles United Healthcare medical necessity denial lawyer. Often, taking legal action is the only way to get insurance companies to cover the treatments and medications they are contractually obligated to cover.
To determine whether United Healthcare is acting in bad faith, a claimant—along with their lawyer—may need to:
- Obtain additional information from the physician that recommended the treatment
- Examine the process and procedures United Healthcare uses to arrive at a decision
- Learn more about other questionable claim denials made by United Healthcare
- Get additional opinions from other medical professionals
- Contact United Healthcare directly
If an attorney can prove United Healthcare acted in bad faith, it may be possible not only to get the insurance company to cover the procedure but also to get United Healthcare to pay compensation to the policyholder.
Let a Los Angeles United Healthcare Medical Necessity Denial Attorney Help
Having a claim for a medically necessary procedure, prescription drug, or medical device can be emotionally crushing. Often, policyholders are left not knowing where to turn, and many end up having to use their own funds to pursue treatment. Fortunately, there may be a way to hold insurers like United Healthcare accountable for acting in bad faith. Call a Los Angeles United Healthcare medical necessity denial lawyer to learn more.