If there is anything worse than being injured or having a serious illness, it is being injured or having a serious illness while dealing with insurance issues. One survey published in August 2024 found that at least 17 percent of adults have had to deal with a health insurance denial over the past year. It is difficult to get accurate statistics on just how many healthcare claims are denied because insurers are not required to release this information. The survey found that denials happen just as frequently for those on employer-based healthcare plans as for those on government insurance plans like Medicare or Medi-Cal.
You may receive a denial before you have even gotten a test, a procedure, or a treatment if your provider submits a request for prior authorization, or you could receive a denial after you have already received the treatment, procedure, or test. Either way, you could be denied a treatment that your doctor believes you need for your health, or you could be stuck with the bill. Imagine, for example, that your doctor orders a PET scan to determine whether your cancer has spread. Your insurer refuses to pay, and you receive a bill in the mail for $13,000.
For most Americans, this would be devastating financially and underscores the fact that most American bankruptcies are the result of medical debt. Should you find yourself in the untenable situation of receiving an Oxnard, CA, health insurance denial, your first phone call should be to the Law Offices of Scott Glovsky. We do this every single day – we fight big health insurance companies, forcing them to provide the care they promised.
Why Are Health Insurance Claims Denied?
You may have received what is known as a “soft” denial, meaning there was missing information on the claim, the claim was miscoded, there were errors on the claim or other easily corrected issues. If your denial letter states that the treatment is not medically necessary or is experimental or investigational, you have a bigger problem. These are usually words that boil down to the fact that the insurer does not want to pay for the treatment because it is expensive.
Insurance commercials have given us the idea that the insurer is our “friend,” ready to lend a helping hand whenever we need it. While it would be nice if this were true, unfortunately, it is rarely ever the case. Insurance companies are often primarily interested in their financial bottom line, so every claim they can delay or deny adds to healthy profits and happy shareholders. Unfortunately, it does nothing for those insurance is meant to help.
What Can You Do if You Receive an Oxnard Health Insurance Denial?
If you have received a health insurance denial letter, it is important that you read the entire letter carefully. This letter should tell you why your claim was denied. The reason for the denial will determine what you do next. If the “fix” is straightforward, you can provide additional information or correct any errors, then resubmit the claim.
If the letter states the treatment was denied because it is not medically necessary, you need to read your policy to determine the appeal process. If you make phone calls to your insurer, be sure to document when you called, the name of the person you spoke to, and what you were told. You should never take “no” as the final answer. Pushing back against a big insurance company is intimidating and can be complex. Insurers know this and know that few people will appeal a denial.
Your internal appeal should include a letter from your doctor that details the reasons you need the medical treatment. An internal appeal asks your insurer to take a second look and reconsider its denial. If the insurer still denies your internal appeal, you can file an external appeal with a neutral third party as detailed in your policy documents. Having an experienced Oxnard health insurance denial attorney from the Law Offices of Scott Glovsky can make this process easier, quicker, and more likely to receive a positive resolution.
Which Insurers are Most Likely to Deny Treatments?
Any insurer can deny treatment, but some may be more likely to do so than others. The primary health insurance companies in the state of California include:
What if Your Insurance Company is Not Communicating with You?
If you find yourself leaving message after message with your insurer and not receiving a response, you need a strong legal advocate as soon as possible. Your health insurance provider has a legal obligation to communicate with you and help you get the medical treatments you need.
Keep track of every phone call and every instance where you attempted to communicate with your insurer. Write a letter to your insurer documenting every time you called and nobody responded. Demand that your claim be evaluated and that you receive a return phone call. Send the letter via certified mail. If no one has answered your concerns within 30 days, speak to an Oxnard health insurance denial attorney who focuses on health insurance denials immediately.
How the Law Offices of Scott Glovsky Can Help Following an Oxnard, CA, Health Insurance Denial
Attorney Scott Glovsky and his legal team fight for justice against big insurers who believe they are untouchable. When an insurer’s claim denial takes you to your lowest point, and you feel ignored, anxious, and stressed about your health, Scott Glovsky can step in and make a positive difference. Attorney Glovsky has many successes to his credit – he has taken on some of the largest health insurance companies and received seven-figure settlements. Even better, he has forced these companies to change their behavior. Contact the Law Offices of Scott Glovsky today.