Do You Have a Teacher Denied Health Insurance Claim?
While the insurance for California is generally pretty good, there are times when a teacher or his or her family could receive a teacher denied health insurance claim. Perhaps you have been a teacher for many years, faithfully paying your health insurance premiums and co-pays, only to be denied a service, test, or prescription drug that you or a family member need. This can be frustrating and potentially a danger to your health as well.
Are Teachers Particularly Vulnerable to Insurance Denials?
Receiving a denial from your health insurance provider can be discouraging—and scary when the treatment, test, or drug is necessary for your health. While California teachers may not be more vulnerable to insurance denials, they are just as vulnerable as non-public employees. Denial is hardly the end of the road. When you’ve received a healthcare insurance claim denial, you have the right to appeal the denial—either on your own or with the help of an experienced attorney.
You will first want to determine why your claim was denied. You should have received written notification of the claim denial that will tell you why your claim was denied. In some cases, it can be something as simple as a coding error, a mistake filling out the forms, or data discrepancies. Other times, the claim might not have been submitted in a timely manner. Other reasons for a claim denial could include:
- The service, test, or prescription drug was prescribed by an out-of-network provider
- The insurer deems the service, test, or prescription drug to be not medically necessary
- The treatment is believed to be experimental
- The benefit you are seeking is specifically excluded from your insurance policy
Once you fully understand why your claim was denied, you will have a better idea of how to approach the situation. If it is an issue that can be easily fixed, you can do that on your own. If, however, your claim is being denied because the insurer believes it is not medically necessary or is experimental, you could benefit from having an experienced attorney help you appeal the claim denial.
While California insurance companies are legally obligated to tell their customers how to file a claim, this is not always the case. In fact, Anthem Blue Cross was forced to pay millions of dollars in fines after improperly categorizing complaints from customers as “inquiries,” meaning they were not obligated to provide crucial appeals process information to those customers. There are many loopholes that insurance companies know and use to their advantage. These loopholes are certainly not to your advantage. A knowledgeable California health insurance claim denial lawyer can help you through the process with the best possible outcome.
As a Teacher, What Should You Do if Your Health Insurance Claim is Denied?
As a California teacher with a denied health insurance claim, you have the right to an internal appeal. This internal appeal requests that your insurance company take another look at the service, test, or prescription drug it denied. The insurance company must conduct a full and fair review of its decision. If the services, test, or prescription drug is urgent to your health, the insurance company is required to speed up the process.
You also have the right to take your appeal to an independent third party for review, known as an external review. Once your appeal goes to an external review, the insurance company no longer has the final say over whether a claim is paid or not. Attorney Scott Glovsky can walk you through the appeal and external review process, handling all the necessary details on your behalf. Scott is never intimidated by a big insurance company’s tactics because he has gone up against these big companies (and won) time and time again.
How Can an Attorney Help Teachers with Health Insurance Claim Denials?
The job of a health insurance claim denial lawyer is to get your claim paid by showing that your insurer wrongfully denied the claim. An attorney can step in at any point after your claim is submitted and can also initiate and litigate a lawsuit that seeks payment of your claim. Having a highly-skilled attorney by your side who can interpret and apply the terms of your healthcare plan as well as the law, increases your chances of success following a claim denial. Having a strong attorney by your side during this difficult process can truly make the difference between a denial and an approval of your claim.
How Can the Law Offices of Scott Glovsky Help Following a Teacher Denied Health Insurance Claim?
There are specific time limits for submitting an appeal, requesting an external review, or filing a lawsuit against the insurance company to force them to pay what they should. As a public employee, your insurer has a lot to risk when they delay, deny, or interfere with your right to treatment, service, or prescription drug. Attorney Scott Glovsky is ready to help change denials to approvals for public employees in LA County, and throughout the state, with offices in Claremont and Pasadena. We have helped thousands of families receive the healthcare they were promised and the treatments and procedures they deserve. Scott and his team will fight hard on your behalf, never backing down until we’ve achieved justice. Contact the Law Offices of Scott Glovsky today.