Public Employee Insurance Denial Attorney Scott Glovsky
Here’s how it works: As a public employee, you’re not subject to laws that restrict what you can recover when you’re wrongfully denied a health treatment or procedure. This means that a health insurer or provider has a lot to risk when they deny, delay, or interfere with your right to health treatments and procedures. You may feel frustrated, angry, and stressed when you have received a public employee insurance denial. The Law Offices of Scott Glovsky will work hard to change that denial to an approval for public employees in LA County and throughout California with our offices in Claremont and Pasadena.
Public employees, including teachers, police officers, and firefighters, have more rights! We help Teachers, Firefighters, Police Officers, other Government Employees (which we explain in greater detail further) and their Family Members fight health insurance denials. The Law Offices of Scott Glovsky has helped thousands of families get the health care treatments and procedures they deserve. As a public employee, you’ve been given special rights that most employees in California do not have.
Our cases have involved health insurers failing to pay for critical treatments or procedures involving:
- Organ transplants
- Cancer treatments
- Traumatic brain injuries
- Psychiatric care
- Behavioral therapies
- Many others
The necessary treatments and procedures may often involve out-of-network health providers, experimental treatments or procedures, and treatments and procedures that the health insurance provider wants someone else to provide. Some of these denials and delays have led to permanent disabilities and even death. In every case, the patient and his or her family have suffered needlessly because of the insurance company’s desire to put profits ahead of people. You are in a great position to ensure that your health insurance provider lives up to its promises, commitments, and legal obligations.
What to Do When You Have Received a Public Employee Insurance Denial
Public employees are in a unique position when receiving a denial of payment for a healthcare claim. Those who obtain private health insurance or are covered by a private-sector employer have certain protections regarding denial of insurance claims, but public employees can sue for damages over and above the medical costs incurred when they receive a healthcare claim denial. It’s important that before a public employee files an appeal, they speak with an experienced health insurance denial attorney like Scott Glovsky.
As with any civil lawsuit, those additional damages could include loss of income, punitive damages, and pain and suffering or emotional distress. This is due to a federal law known as ERISA. Under the Employee Retirement Income Security Act of 1974, public employees have a guaranteed right to appeal any health insurance claim denial. There are three primary steps associated with this first level of appeal.
Suppose you have filed a normal claim with your health insurance company, and that claim was denied, accompanied by a written explanation of the denial. Once you have received this written explanation of denial, you can request an internal review with the company. Be aware; this request must be submitted within 180 days from the date your claim was denied. You will be asked to submit any additional documentation supporting your request for a specific medical procedure or prescription drug. You will probably include a letter from your doctor that explains why the procedure or prescription drug is necessary.
It is extremely important that you keep copies of every piece of paper associated with your claim, the denial, and your appeal, including your Explanation of Benefits, and the request sent to your insurance company for the internal review. An internal appeal must be completed in 30 days or less if you are waiting for the treatment or services. If your claim is still denied through the internal review, you can file an external review within 60 days of the date you were informed of the internal review denial. The external reviewer will either agree with the internal review to deny your claim or will find in your favor.
For most people, this is where the process ends. If you are a public employee, however, an external review is not your final option. You now have the option of filing a lawsuit against your insurance provider. Just the act of filing the lawsuit could produce enough leverage to convince your insurance provider to settle your claim, particularly if you have a public employee insurance denial attorney on your side. Further, this lawsuit could result in a settlement that not only covers the disputed medical treatment, it could also cover loss of income, pain, and suffering, and punitive damages if bad faith is proven on the part of your insurer.
Which Public Employees are Vulnerable to Insurance Denials?
- Teachers are usually employed by school districts, which include health insurance in the benefits package. These benefits are negotiated locally between districts and unions. In the face of spiraling healthcare costs, schools, like most employers, are struggling to sustain benefits. Many years ago, teachers were provided lifetime health insurance through their school district, but benefits like this are uncommon today. In any case, teachers, like other public employees, have an extra option after filing an internal and external review of their claim denial. They can file a lawsuit against their insurer, potentially receiving payment for the claim as well as additional damages.
- Professors, like teachers, generally have fairly good medical benefits, whether that comes in the form of a PPO, HMO, POS, or HDH. No matter which insurance plan is chosen, professors may file a claim against their healthcare provider following an insurance denial and an internal and external review as a public employee.
- Firefighters, like other public employees, are generally offered better-than-average healthcare insurance, as well as disability payments if they are injured on the job. The healthcare packages usually include health, dental, and vision for all full-time employees and for some part-time emergency employees. Following an external and internal review, firefighters have the right to file a claim against their healthcare provider.
- Police Officers are usually offered healthcare insurance that significantly exceeds plans offered by private employers. When a healthcare claim is denied, police officers can appeal internally, then externally, then have the option of bringing a lawsuit against their healthcare provider.
- Employees of public institutions include anyone employed by a government agency, including employees in municipal, county, state, or federal agencies. Employment in the public sector can be more stable with desirable retirement and health benefits, compared to job in other sectors. Animal control officers, correctional officers, bailiffs, coast guard personnel, immigration and customs inspectors, military personnel, city attorneys, managers, planners, public health nurses, guidance counselors, superintendents, principals at public schools, and many more workers are considered employees of public institutions. As such, these public employees have the extra layer of protection when denied a healthcare service or treatment.
How Can the Law Offices of Scott Glovsky Help Following a Public Employee Insurance Denial?
A public employee insurance denial can be devastating. At the Law Offices of Scott Glovsky, we can help you file your internal and external review and file a lawsuit if needed. If those are unsuccessful, we can file a lawsuit against your healthcare provider. If you or a loved one have been denied healthcare coverage, the Los Angeles, Claremont, and Pasadena health insurance denial lawyer Scott Glovsky can help! You can learn more by exploring our website or simply giving us a phone call at (626) 604-6973. You can also complete the form on our website filling out our form for a free consultation. Contact the Law Offices of Scott Glovsky today.
We want to help.