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San Bernardino Health Claim Denial Attorneys
San Bernardino County is the largest county in the contiguous United States with an area of 20,105 square miles. San Bernardino County is located in the southern portion of California, and with a population of 2,035,210 as of the 2010 census, is the fifth-most populous county in California. The city of San Bernardino is the county seat of San Bernardino. While there are 24 incorporated cities and towns in San Bernardino County, the city of San Bernardino is the heartbeat of the county.
Like people across the nation, San Bernardino residents can find themselves on the denial end of a healthcare claim. Many legitimate healthcare claims are either denied outright, or payment is delayed time and time again. Attorney Scott Glovsky understands just how frustrating it can be when you have faithfully paid your healthcare premiums for months or years, only to have your legitimate claim denied. You should know that your insurance company owes specific legal responsibilities to those it insures. When the insurance company does not meet those responsibilities, it could be liable for any resulting damages.
Unlike other firms, the Law Offices of Scott Glovsky purposely takes fewer cases to be highly attentive to each client. In this fight alongside you, we listen carefully to your needs as we determine the best next step for you and your future. We will ensure you are never just a case number—we will hear you at every turn and fight for justice on your behalf.
San Bernardino County Health Insurance Companies May Unfairly Deny Claims
If you have health insurance—or other types of insurance—you should know that your insurance company owes you specific basic responsibilities. While insurers deny claims sometimes for a valid reason, they also sometimes deny simply to protect their own financial bottom line. If you have had a healthcare claim denied, you must determine the insurance company’s explanation for the denial. In some instances, a claims processor could make a mistake; there may be missing information on the claim or the information may be entered into the system incorrectly.
Make sure your claim was denied rather than rejected. A reject is when it is not processed because of incorrect information. If your claim is rejected, you do not need to appeal the decision; you only need to provide the correct or missing data. Once that is done, the claim can process. A health insurance claim denial occurs when there is a denial to pay for a specific procedure, prescription, or test. A denial can be appealed, either by you personally or by your attorney. Because the process is often complicated, it can be beneficial to have your San Bernardino County health insurance denial attorney explain the steps and handle the paperwork on your behalf.
Your appeal letter will be as matter of fact as possible and will include any information required by your insurance company. Your medical history and health problems will need to be explained, as well as why you need the test, treatment, or prescription, and why it is a medical necessity. If there are institutions that show the particular test, treatment, or prescription as part of a recognized treatment plan, your attorney includes this fact. There will be specific time limits on your appeal which are crucial to potential approval.
What are the Primary Reasons for San Bernardino Healthcare Denials?
Like most people, you have probably been paying healthcare premiums for many years. Then, when you really need your insurance company to come through for you, it denies your claim. You never have to simply accept such a denial. The most common reasons for a healthcare claim to be denied include:
- A medical billing code error on your claim.
- Having filed incomplete or missing information in the claim.
- The health insurance plan failed to deem your procedure, test, or prescription medically necessary.
- Having exceeded the coverage limits of your healthcare plan.
- Having requested prescriptions or therapy that is not a part of your healthcare plan.
- Having used an out-of-network provider or service.
- Having used your health insurance out of state.
- Having failed to have your surgical procedure pre-approved by your insurance company.
- Your insurance company wanted to pay for a generic, rather than a name brand prescription medication.
- Having filed a claim before the end of your waiting period provision.
- Having received out-of-network emergency care, even though you were in no position to contact your insurer for pre-approval.
- The Insurance agent finds your disease is too “rare” to be covered.
- Your surgical procedure was initially pre-approved, then the insurer denied the claim after it realized how expensive the procedure was.
In other cases, insurance denies your healthcare claim simply because the medical personnel who works for the insurance company and reviews your claim was not qualified to make that decision. In other words, a general practitioner might be making a denial for an oncology procedure that he or she knew little about.
San Bernardino County Insurance Law Attorneys
If your health insurance claim is denied, you need an advocate in your corner—an attorney who will work hard on your behalf to help you get your claim approved. The Law Offices of Scott Glovsky is nationally recognized as a strong advocate for injured insurance policyholders’ rights. We will take an aggressive stance with your insurance company, ensuring your medical needs are met. 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.
