Having to go into the hospital for surgery, no matter how minor, is often a stressful time in a person’s life. Not only are the potential for complications and a long recovery time daunting, these procedures routinely cost tens of thousands of dollars. Most people have some form of health insurance that helps pay for the majority—if not all—of the costs associated with a surgery. However, many insurance companies in California put up a fight when it comes to paying for such a procedure. These companies may cite a number of reasons for doing so, ranging from cost issues to questions regarding the necessity of the surgery. If you are facing an insurance company that has denied coverage for a surgery, schedule a legal consultation with a Los Angeles surgery denial lawyer.
An accomplished attorney who is well-versed in surgery denial cases could help a person determine legal options. This may include filing an appeal to dispute the insurance company’s denial of coverage for the surgery.
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Why Might an Insurance Company Deny Coverage for a Surgery?
Insurance companies frequently make their profits by collecting premiums from customers and either rejecting claims or partially paying claims. To accomplish this goal, they may utilize many strategies and technicalities to avoid issuing payments.
Denials could happen for any number of reasons, but the ultimate effect is generally the same where a person could be left unable to pay for an already completed treatment, or they may never receive their medically necessary treatment at all. Since insurance coverage denials may have a crippling effect on a person’s health or finances, it is typically important to be aware of common tactics used by insurance companies to avoid paying for a surgery. Set an appointment with a Los Angeles surgery denial lawyer to learn more about the process an insurance company may use to avoid covering an individual’s surgery expenses.
Medically Necessary for Surgery
In an ideal situation, a person who is requesting surgery, their doctor, and the insurance company would discuss the medical necessity of a surgical procedure and any payment plan for any medical procedure before it occurs. This typically allows the insurance company to decide whether they will pay for the surgery, whether it is medically necessary, and the expected extent of follow-up treatment.
However, if an insurance company decides that the treatment is not medically necessary, is experimental, or is purely cosmetic, they may deny payment. This could result in treatment being withheld by doctors or hospitals. When a person is denied a medically necessary surgery, their health may suffer to a potentially serious or even fatal degree.
Defining an Emergency Surgery
In some situations, the staff in an emergency room may be forced to perform a surgery to save the life of a patient. This commonly occurs in instances of:
- Heart attacks
- Strokes
- Catastrophic injuries
- Gunshot wounds
When this is the case, a hospital generally attempts to take a person’s insurance information but typically still performs the procedure if coverage cannot be confirmed. If an insurance company later denies coverage, the patient could be left with astronomical bills for something that was completely out of their control.
No matter if the surgery was an emergency that required immediate care, or a person needs surgery but their insurance company denies payment before the procedure takes place, people generally have the right to appeal all denials of coverage. A surgery denial attorney in Los Angeles could work with people who need immediate surgery to improve their quality of life but was denied coverage by their insurer.
Let a Los Angeles Surgery Denial Attorney Help
Undergoing surgery is already a uniquely stressful time in your life, and having to fight insurance companies for coverage could make the process even worse. These companies may deny a claim for many reasons that prevent the surgery from happening or place the financial burden for the procedure on the patient themselves. A Los Angeles surgery denial lawyer could help you file an appeal against such a decision correctly and in a timely manner.
Whether this appeal is pursued through the insurance company’s internal procedure or is filed with the State of California’s Department of Managed Healthcare, a dedicated injury attorney could work to represent your interests and help you pursue important medical coverage.
