Los Angeles Medical Necessity Denial Appeals

Health insurance is supposed to provide you with peace of mind with the knowledge that, if you become sick or are injured, you will have help paying for your medical expenses.
However, each year thousands of Americans are denied their medical necessity claims leaving them frustrated, hopeless, or in significant medical debt. You should know that you have rights when you are denied medical necessity benefits by your health insurance company. A seasoned insurance attorney can help you with Los Angeles Medical necessity denial appeals.

Why Los Angeles Medical Necessity Claims are Denied

Medical necessity claims are denied in Los Angeles for numerous reasons. Many of these denials could potentially be avoided if the insurance carrier was more thorough when reviewing the claim.
For example, according to the United States Government Accountability Office, some claims are denied simply due to a clerical error or the wrong billing code.

Others may be denied because the insurer claimed that the insured did not provide enough medical information to establish a necessity. Regardless of the reason, the policyholder generally can appeal the decision. If a person’s medical benefits were denied, they can work with an attorney who can help them pursue Los Angeles Medical necessity denial appeals.

Legal Obligations of Insurance Carriers

For group health plans that are subject to ERISA, health insurance carriers have several obligations to their insured. One of these obligations is to provide timely information on the acceptance or denial of a claim. Another is to have an appeals process in place that includes a full and fair review of the claim. In accordance with the law, the insurance carrier must provide the following for a full and fair review:

• At least 180 days to file an appeal after receiving the notification of a Los Angeles medical necessity denial
• The ability to add records, written comments, or other related information to their claim file
• Free and reasonable access to copies of all documents and records related to the claim
• Consideration of all information submitted for the claim, regardless of whether the information was originally submitted or submitted with an appeal
• A review that is done by a neutral party
• Identification of any medical experts who reviewed the initial claim or appeal and provided advice to the insurance carrier

California law imposes similar requirements upon insurers of individual or family health plan members who has denied a claim for coverage. Those who feel their initial claim or appeal was not handled in accordance with these laws should consult with a Los Angeles medical necessity denial lawyer. The lawyer can review all the claim records to help ensure the insurance met all of their obligations.

Getting Legal Assistance for Medical Necessity Denial Appeals

If you are ready to learn more about filing denial appeals, contact a well-versed Los Angeles medical necessity denial attorney today. An attorney can help you work to get your medical necessity denial overturned. They are familiar with what it takes to make an insurance appeal more successful and can assist you through every step of this sometimes confusing and arduous process.

Do not try to navigate the Los Angeles medical necessity denial appeals process alone. An attorney can work with you throughout the process to help you get the coverage you need. Call today to learn how an attorney can help you.