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Where to Turn When Your Health Insurer Has Denied You a Service or Treatment
Experienced Health Insurance Denial Attorney Scott Glovsky
It can feel like a devastating betrayal when you have faithfully paid your healthcare premiums for months or years, then when you need your health insurance, your claim for a particular service or treatment is summarily denied. You suddenly find yourself frustrated and overwhelmed, unsure of what steps you need to take or whether you can even fight this injustice. It is important to remember during this difficult time that you are not alone. All you need is one person willing to fight for your rights and your future.
Attorney Scott Glovsky is that person. At the Law Offices of Scott Glovsky, we fight aggressively, with every bit of experience and knowledge we possess, to force insurance companies to change their behavior. This can include requiring them to rethink their current process of reviewing requests for medically necessary treatments. We want to help you by using every legal measure at our disposal to force your insurance company to do the right thing. Attorney Scott Glovsky can beat up your insurance company—just ask Anthem Blue Cross, Blue Shield of California, Health Net, Kaiser, Aetna, and United Healthcare.
About Molina Healthcare
Molina Healthcare was founded by a California emergency room physician, Dr. Molina, in 1980, in response to seeing patients flood his Long Beach ER for minor illnesses, simply because their regular doctors would not take Medi-Cal. Dr. Molina’s sons ran the company after their father died in 1996, then in May 2017 Joseph M. Zubretsky, the former CFO of Aetna, became the president and CEO of Molina Healthcare. Molina Healthcare contracts with state governments in fourteen states providing a health plan that offers a wide range of medical coverage to those who qualify for Medicaid and the State Children’s Health Insurance Program.
Molina Healthcare also offers Medicare Advantage and Integrated Medicaid/Medicare plans as well. In many of the states, Molina Healthcare also offers Marketplace as result of the Affordable Care Act; in some cases, allowing Medicaid members to stay with their providers as they transition from Medicaid to Marketplace. Molina Healthcare advertises that they keep members’ out-of-pocket expenses to a minimum.
When Molina Healthcare Denies Your Claim
When you signed up with Molina Healthcare, you assumed it would protect you if you become sick or injured. If Molina Healthcare denies your claim, you can end up devastated, struggling with massive medical expenses. If it denies your claim for no good reason, you have the right to appeal that decision. Attorney Scott Glovsky can help you manage a health insurance denial from Molina Healthcare by reviewing your current policy, then pursuing all legal avenues to your right to healthcare coverage.
What Are Common Reasons A Molina Healthcare Insurance Claim is Denied?
A bad faith lawsuit can be filed against Molina Healthcare when it denies a healthcare claim without a legitimate justification. After all, health insurance companies have a duty of good faith and fair dealing to the people they insure. For Molina Healthcare—as well as other healthcare providers—the most common reasons for denying treatment or service are clerical errors, the determination that a treatment is medically unnecessary, or a claim that the procedure is investigational. Far too often, even routine practices (MRIs, x-rays, and CT scans) can be deemed “investigational.”
Health Insurance Delays by Molina Healthcare
Aside from healthcare denials of legitimate claims, insurance companies like Molina Healthcare often engage in health insurance delays even though California law mandates that health insurance companies provide timely access to care. These health insurance delays can include a delay in prompt payment for a medical procedure or a delay in denial. Health insurance companies must, under the law:
- Provide those insured under Molina Healthcare with access to telephone triage
- Provide those insured under Molina Healthcare with a screening service
- Provide those insured under Molina Healthcare with access to a hospital or primary care provider within 30 travel minutes of their work or home
- Provide those insured under Molina Healthcare with urgent service appointments that do not require approval within 48 hours
- Provide those insured under Molina Healthcare appointments for non-services that do not require approval within 96 hours
- Provide those insured under Molina Healthcare access to a competent customer service representative for health plan advice within a reasonable amount of time.
How Scott Glovsky Can Help if You’ve Had a Coverage Denial from Molina Healthcare
Like most people, you expect that your insurance company will come through for you when you need it most. Because you pay your premiums as required, it can be incredibly disheartening to find that your insurance company has denied a service or treatment. Not only does such a denial leave you wondering what you should do next for your health and your future when you are ill, you simply may not feel like fighting with your insurance company—even when it is something you desperately need.
At the Law Offices of Scott Glovsky, we want to take this burden from your shoulders, allowing you to concentrate on your health. At the same time, we fight for your rights. Attorney Scott Glovsky will file an initial appeal with Molina Healthcare, create a case before the California Review Board, or argue your case in court. Contact the Law Offices of Scott Glovsky today—we have the experience, knowledge, and skills to go up against Molina Healthcare—or any large healthcare company.
