Los Angeles United Healthcare Health Insurance Denial Lawyer

Your health insurance policy with United Health Care is supposed to provide for you and your family when you are sick or injured. However, all too often policyholders make a claim with United Healthcare only to have their claim denied.

Having a health insurance claim denied can be devastating, forcing people to forego medical treatment and leaving families to struggle with massive medical bills. Unfortunately, health insurance companies such as United Healthcare often deny health insurance claims for baseless reasons such as a belief a treatment is not medically necessary or a refusal to approve a specific procedure in favor of mandating another cheaper course of treatment.

If you were denied health insurance coverage by United Healthcare, you should be aware that you have the right to appeal any decision. A Los Angeles United Healthcare health insurance denial lawyer could help you manage a health insurance denial appeal by reviewing your policy and aggressively pursuing your right to health coverage. Contact an attorney today, and know that you are in capable hands.

Common Reasons Why Health Insurance is Denied

If you believe that your insurance company denied your health insurance claim without any justification, you may be entitled to file a bad faith lawsuit against United Healthcare. Under California Insurance Code §790.03, insurance companies are prohibited from engaging in unfair practices such as “misrepresenting to claimants pertinent facts or insurance policy provisions relating to any coverages at issue.”

Prior to the Patient Protection component of the Affordable Care Act—more commonly known as “Obamacare”—the most common reason why a health insurance was denied was because a person had a pre-existing condition.  Since the passage of this bill, insurance companies such as United Healthcare have turned to other tactics to deny a person health coverage, including but not limited to:

  • Clerical errors – health insurance claims or policies can sometimes be denied because of a simple clerical error either on part of the insurance company or the applicant, even though this should not be a determinative factor in denying a claim
  • Deeming treatment medically unnecessary – insurance companies often claim that a procedure is not medically necessary, supposedly by having an internal doctor review a claim
  • Claiming the procedure is investigational – Insurance companies may legally claim that a procedure is only investigational and therefore refrain from covering it, but they often extend this concept too far and claim that routine practices such as x-rays, MRIs, and CT scans fall into this category

Health Insurance Delays

United Healthcare and other insurance companies have a duty to provide either prompt payment for a medical procedure or a prompt denial. Furthermore, California law mandates that health insurance companies provide timely access to care. This means that health insurance companies such as United Healthcare must:

  • Provide insured individuals access to a primary care provider or to a hospital that is within 15 miles or within 30 travel minutes of their home or work
  • Provide appointments for urgent services that do not need approval within 48 hours
  • Provide appointments for non-services that do need approval within 96 hours
  • Provide access to telephone triage or a screening service
  • Provide access to a knowledgeable and competent health plan customer service representative in a reasonable amount of time

If insurance companies do not provide these services to insured individuals, individuals could consult a Los Angeles United Healthcare health insurance denial lawyer who could advise them on how to proceed.

Calling a Los Angeles United Healthcare Health Insurance Denial Attorney

If you or a loved one had your health insurance claim denied by United Healthcare, call a Los Angeles United Healthcare health insurance denial lawyer today. An aggressive and experienced attorney could help you appeal a health insurance company’s decision and work on your behalf to secure the benefits you are entitled to under your insurance policy.