Sacramento Health Insurance Denial Attorney
While Sacramento is considered a diverse, beautiful place to live with a high quality of life, residents have the same issues with health insurance denials as those across the United States. When facing a health insurance denial that could have a significant impact on your own quality of life and your future, having a strong health insurance denial attorney like Scott Glovsky on your side can make all the difference.
What Are the Reasons Your Health Insurance Claim Could Be Denied?
A Harmony Healthcare study found that claim denials have increased by as much as 20 percent over the past five years, due to a number of issues. The average rate of healthcare claim denials upon initial submission had risen to almost 10 percent as of the end of 2021. While some healthcare claims denials are due to such things as incomplete paperwork, incorrect coding, patient eligibility issues, or missing or incorrect data, these can usually be easily corrected. The more insidious—and harder to fight—claim denials may be based on the following:
- Failure to obtain prior authorization
- Site of service exclusions
- The procedure is not medically necessary
- Treatment or medication is considered experimental
- Inaccurate enrollment files
- Excluded serve
- Observation status or short-stay denials
- Sepsis or malnutrition diagnoses
- Above usual and customary charges
- Treatment or medication deemed not medically necessary
What Should You Do if Your Health Claim is Denied?
If your health claim is denied, you do have options. There is an appeal process (detailed below) that has several steps, as well as an expedited process if waiting on a decision would damage your health. It can be overwhelming to deal with the claims denial process on your own. Having an experienced, knowledgeable health insurance denial attorney from the Law Offices of Scott Glovsky can make a significant difference in the outcome of your appeal.
Scott has been fighting for Californians since 1999 after working for a number of years representing big insurance companies. This means that Scott knows how those insurance companies think and what tactics will be successful. You purchased your health insurance for peace of mind, trusting your insurance company to be there when you need it. Attorney Scott Glovsky is ready to help you get the treatment or medication you need as quickly as possible.
Which Insurance Companies are Known to Deny Treatments?
Any insurer can deny an insurance claim, although some are more likely to do so than others. For most insurance companies, the financial bottom line is the biggest determiner of whether they will pay any particular claim. The more claims they can plausibly deny—and get away with—the better for the company. Californians may have dealt with health insurance denial claims from any of the following insurers:
How Do I Appeal a Health Insurance Denial?
If your claim is denied by your insurer, you have the right to an internal appeal, meaning you can ask your insurer to conduct a review of the negative decision. In the state of California, insurers must legally tell you how to appeal a claim, but this does not always happen. In fact, Anthem Blue Cross was forced to pay millions in fines after it categorized complaints from customers as “inquiries,” thus skipping the requirement to tell policyholders how to file an internal appeal.
You must file an internal appeal prior to filing a third-party grievance. Having an experienced health insurance denial attorney from the Law Offices of Scott Glovsky can help you get the medical treatment or medication you need. Scott will also ensure you do not miss a crucial deadline which could cause you to lose your right to bring a lawsuit if your appeals are not correctly exhausted.
Your internal appeal must be filed within 30 days of receiving your denial letter. Obtaining a letter from your healthcare provider can go a long way toward a successful appeal. Your insurer can explain why you need the medical treatment or medication—i.e., why it is medically necessary and is not experimental. If your case is urgent, you must contact your insurer and ask about applying for an expedited internal appeal.
“Urgent,” means that waiting 30 days would seriously jeopardize your health, life, or ability to regain function. You should receive a decision on your internal appeal within 30-60 days depending on the reason for your appeal. An independent third-party review—or external review—is the part of the process where you will ask that your insurer’s decision be reviewed.
The type of plan you have will determine where to file your independent medical review. If the Department of Managed Healthcare (DMHC) is overseeing the independent medical review, the process should take no more than 30 days, or, if your review is urgent, no more than 7 days. If the decision is still unfavorable, you can file a complaint, and, potentially, a lawsuit against your insurer.
Does My Appeal for a Health Insurance Denial Stand a Chance?
One report found that out of all the denied claims, a full 65 percent are not challenged by the medical professional or the insured. Most people are unsure of how to proceed with an insurance denial, so if it is not a life-and-death situation, they simply accept the decision of their insurer. This is what insurers are counting on—that people are busy and will either give up, miss a deadline, or fill out the necessary paperwork incorrectly. Don’t let this be you! Attorney Scott Glovsky will be the advocate you need to help ensure that your insurance claim denial is reversed.
How Sacramento Health Insurance Denial Attorney Scott Glovsky Can Help
Having a highly skilled health insurance denial attorney from the Law Offices of Scott Glovsky can make a difference in whether your denial is eventually reversed. Scott has been helping people just like you for more than two decades. He has a thorough understanding of the laws and rules surrounding health insurance claim denials and will fight for you and your family to ensure you get the medical treatments you need. Contact the Law Offices of Scott Glovsky today.