California Health Claim Denial Attorney Scott Glovsky
Orange County, California is commonly known for Anaheim’s Disneyland, Knotts’s Berry Farm, and its many surf beaches, including Huntington Beach, Newport Beach, and Laguna Beach. With a population of 3.176 million residents, Orange County is the third-most populous county in California, the sixth-most populous county in the United States. It has more residents than 21 of the states in the United States.
Unfortunately, like residents across the nation, Orange County residents may find themselves frustrated by a healthcare insurance company that denies a legitimate claim. A health insurance company could delay your claim time and time again or deny it outright.
It hardly seems fair that after you have done the right thing by always paying your insurance premiums, your insurance company is now doing everything in its power to avoid doing the right thing for you. Attorney Scott Glovsky will never back down from a fight with a large health insurance company. At the Law Offices of Scott Glovsky, we have dealt with delay and denial tactics for many years. We know precisely how to expose those tactics and get the money you are entitled to receive.
Orange County Health Insurance Companies May Unfairly Deny Claims
Unfortunately, healthcare insurance companies may unfairly deny a claim simply because they have unqualified medical personnel reviewing claims for policyholder treatments. As an example, suppose you are requesting treatment for radiation due to your breast cancer. Your insurance company may assign a family practitioner to determine whether the treatment is covered. You have a right to expect your claim to be carefully reviewed by a doctor or nurse with proper qualifications who fully understands the medical issues at hand.
Further, health insurance companies may be placing excessive pressure on their employees to handle many claims within a short time window. Overworked employees may not be able to spend sufficient time reading the medical records, the language of your policy, and the appeals sent by your treating doctors before determining whether they will pay your claim. Rushed decisions can result in unfair denials and need to be looked at by a qualified attorney.
Healthcare professionals working for the insurance companies may be biased because they place their employer’s interests above your interests—the policyholder who has faithfully paid your premiums for months or years. Insurance should give your interests at least equal regard as their own, but that is not often the case. When healthcare professionals are compensated in a way that gives them a financial incentive to deny policyholders’ claims, there is a real danger of bad faith denials.
What are the Primary Reasons for Orange County Healthcare Denials?
After years of faithfully contributing to your healthcare premiums for you and your family members, you may be dismayed to find your insurance company denying benefits you or a family member are entitled to receive. You do not have to simply accept a healthcare denial. The following are common scenarios when your healthcare insurance my try to deny your claim:
- Surgery is one of the most commonly denied procedures since it is generally a costly proposition. Most healthcare companies require pre-approval for any surgical procedure that is not the result of an emergency. Even though most insurance policies also state that a pre-approval does not necessarily constitute a coverage decision, you should always do this. If you do everything you are required to do; however, you will be better positioned should the surgical claim be denied.
- Insurance may deny a surgical claim on the grounds that they did not find it medically necessary. Your insurance company may claim there was another (less expensive) option than the surgical procedure you chose.
- Another commonly denied charge is for name-brand prescriptions. Your health insurance company may argue for a generic prescription, even when your medical provider has advised you to take a name brand.
- Many people are unaware of the “waiting period provision” found within their insurance policy. Insurance companies sometimes use this provision to deny your claim.
- In some instances, your health insurance company may deny out-of-network emergency care, even though you were in no condition to contact an insurer for pre-approval.
- Health insurance companies may claim that your disease is too rare for coverage, with only a few specialists in the country, or may withhold treatment or a procedure because they consider it “experimental,” even though the medical community disagrees.
- Health insurance companies may initially approve a medical procedure, then reverse position after the surgery is complete, and realize how expensive it was.
Orange County Insurance Law Attorneys
Health insurance should protect you if you suffer injuries, illness, or need tests to facilitate a medical diagnosis. Unfortunately, far too many health insurance companies are more interested in their shareholders and their financial bottom line than their policyholders. Some insurance companies have a deliberate policy of delay and denial tactics. When you are having difficulty with your health insurance company and cannot obtain a procedure or test you need, or payment is experiencing delays, it is good to have an advocate in your corner.
If you are like most people, you have no idea where to start or how to proceed when fighting a health insurance denial. It can be a challenging journey when you are fighting to receive necessary healthcare treatment, particularly when trying to do it on your own. This is why you must choose a highly experienced attorney like Scott Glovsky, that is nationally recognized as a strong advocate for the rights of the injured and insurance policyholders.
You need an attorney who will take an aggressive stance with your insurance company, ensuring your medical needs are properly met. If you feel overwhelmed, the Law Offices of Scott Glovsky have the experience and skills necessary to help you through this difficult time. We never want you to feel like fighting your health insurance company is a losing proposition. Contact the Law Offices of Scott Glovsky today for a review of your health insurance denial.