Perhaps you have been in relatively good health most of your life and may have even rarely used your health insurance. But the reason we have health insurance – or any type of insurance – is for when the unexpected occurs. Suppose you are in an accident and are severely injured or you are diagnosed with a serious illness. Suddenly, everything has changed, and your very life depends on the medical treatments you receive now and in the future.
While you may not have thought much about health insurance denials before, now it is a huge worry in your life. Suppose your doctor sends you for a $13,000 PET scan to determine how far your cancer has spread (which will determine future treatments) or sends you for a $4,000 CT scan because you have chronic, intense back pain after an injury. If these treatments are subsequently denied by your insurance company, how will you get the medical treatment you need?
Most people cannot afford this level of expense. If you need the treatment and your insurer refuses to pay, do you just quietly live your life in excruciating pain or wait to die from cancer? This is not what the medical insurance industry should be, yet here we are. Since insurers are not required to reveal how many insurance claims they deny, it is impossible to have accurate figures.
Some surveys of those who are insured reveal claim denial rates that range from 13 percent to a whopping 40 percent. Receiving an Oakland, CA, health insurance denial can be extremely discouraging. After faithfully paying your monthly premiums for years or decades, your insurer suddenly refuses to pay a claim that could make a difference in your life.
Now is the time when a strong legal advocate in your corner can truly make a huge difference in the outcome of your claim denial. Attorney Scott Glovsky helps people in your situation virtually every day and has a long history of successfully fighting big insurance companies – and winning.
Why Are Health Insurance Claims Denied?
Your claim could have been denied because it was missing necessary information, had errors in the paperwork, or was miscoded. These are all common problems that can be easily fixed. If your denial is the result of not using in-network providers, or if you missed a crucial deadline, these issues are much more difficult to fix.
Often, there is language in your denial letter like “not medically necessary,” “investigational,” or “experimental.” These words are often “insurance code” for “too expensive.” If you suspect this is the case, you must file an appeal to make your insurance company reconsider its denial of the claim.
What Can You Do if You Receive an Oakland, CA, Health Insurance Denial?
If you have received an insurance claim denial, it is important that you not give up, at least until you have explored every avenue to get the insurer to pay for your medical treatment. You can first file an internal appeal, which is usually more likely to be successful if a letter from your doctor that details all the reasons you need the recommended treatment is included along with your appeal.
An internal appeal asks your insurer to reconsider its earlier denial. If your internal appeal is unsuccessful, you can file an external appeal with a neutral third party. If this appeal is favorable, your insurer will be forced to reverse the denial. If your insurance company has exhibited bad faith, you can file a bad faith insurance lawsuit against the company. All of these are more likely to be successful when you have an aggressive, knowledgeable Oakland health insurance denial attorney by your side.
Which Insurers are Most Likely to Deny Treatments?
While any insurer may deny medical treatment, some appear more likely to do so than others. The following are the most common health insurers Californians have:
How Often Are Denied Decisions Overturned?
A KFF study published in 2023 revealed that claim denials are overturned at least 40 percent of the time, which makes it well worth your time to appeal an adverse decision. While it can seem like an uphill battle with little chance of success, this is not the case. Insurance companies may routinely deny certain medical treatments, particularly those that are more costly. Often companies know that if they are called on the denial, they will probably have to pay it, at least eventually. They also know that only about 1 percent of those who receive a denial will appeal, so the odds are actually in their favor.
How the Law Offices of Scott Glovsky Can Help Following an Oakland, CA, Health Insurance Denial
If you have received an Oakland, CA, health insurance denial, you need a highly skilled, aggressive insurance denial attorney like Scott Glovsky. Scott is ready to help you get the justice you need and deserve. His firm has a long history of success against large insurance companies and many satisfied clients. You do not need to accept a health insurance denial that can have devastating effects on your health and future. What you can do is contact the Law Offices of Scott Glovsky and discuss your health insurance denial with a compassionate, experienced claim denial attorney.