Preventing Medical Necessity Denials in Los Angeles

If you are like most Americans, health insurance provides you with the peace of mind that if something happened to you or one of your family members you would have help paying your medical bills. Unfortunately, this is sometimes a false assumption.

Denial letters sent from insurance companies who are for-profit are relatively common and force families to fight for the coverage they need. However, a skilled insurance attorney can assist you in preventing medical necessity denials in Los Angeles.

Preventing Medical Necessity Denials When Filing a Claim

Preventing medical necessity denials in Los Angeles is often easier than having to deal with the problem once the claim is denied. While the policyholder can file an appeal if their claim is denied, there are ways to help increase the odds the claim will be approved the first time.

To begin, health insurance companies are required to set up reasonable procedures surrounding benefit claims as per 29 CFR 2560.503-1 and California law including the Knox Keene Act and the Insurance Code. The claimant needs to find out what these procedures are and follow them as closely as possible.

There can never be too much information in a medical claim. It should make sense to everyone who will determine the fate of the claim. Providing all possible evidence and information about why a treatment is a medical necessity is a way to prove that a claim should be accepted. It can also help if the information is clear and well-organized.

Seek Information from Health Care Providers

Anyone filing a claim for a medical necessity should make sure their doctor is supportive. Doctors who are willing to take the time to fully explain the patient’s medical needs to the insurance carrier should include this information in the claim.

It can also help for claimants to fully understand any medical issues they have and why they need the test or treatment their doctor ordered. When they understand these concepts, they can better explain and uphold them to the insurance carrier. Seeking such information could help with preventing medical necessity denials in Los Angeles.

Benefits of Working with a Los Angeles Attorney

An experienced medical necessity denials attorney will have a good idea of the best ways to get a claim accepted the first time. They are familiar with different health insurance companies and their specific requirements. An attorney can also speak to the policyholder’s doctor and insurer on their behalf, saving them time and decreasing their stress.

Additionally, medical necessity claims that have lawyers behind them often get more serious attention than others. In fact, many medical necessity claims can be related to small bureaucratic issues such as an incorrect billing code or a missing signature or form that a lawyer can avoid.

How an Attorney Can Prevent Medical Necessity Denials in Los Angeles

While following these tips will not always be able to prevent a denial, preventing medical necessity denials in Los Angeles should be your goal. When you consult with an attorney who can represent you in your medical necessity claims case, that is their goal as well.

Lawyers work hard to provide you with a compassionate representation that can increase the chance that your claim will be successful. Call today to learn more about how an attorney can increase your success when it comes to medical necessity claims.