While denial rates from health insurers vary widely (1-57 percent of in-network claims), in 2019, 34 of the 122 major medical issuers had a denial rate of about 10 percent. Another 45 reporting insurers had a denial rate of in-network claims of 10-20 percent, 32 insurers denied 20-30 percent of in-network claims, and 11 insurers denied more than 30 percent of in-network claims. If you, like most people, have spent years paying your health insurance premiums only to have a claim denied, you may feel very discouraged. You could fail to receive the medical treatment you need because of the denial or be forced to pay for the treatment on your own. Although health insurance denials are relatively common, most of us do not have the slightest idea how to fight such a denial. When you are looking at fighting a huge, impersonal company, you should strongly consider speaking to an experienced Riverside health insurance denial attorney.
With so much at stake, which insurance bad faith attorney you choose really makes a difference in the outcome. Attorney Scott Glovsky is a nationally recognized advocate for the rights of injured insurance policyholders. We work hard to help those denied insurance coverage obtain the benefits they need—and pay for. Attorney Scott Glovsky expects and understands every single tactic typically engaged in by insurance companies.
Unlike the television commercials that portray insurance companies as your best friend in a time of crisis, most insurance companies go out of their way to delay, deny, and underpay claims. The Law Offices of Scott Glovsky has represented policyholders since 1999, consistently seeking justice for its clients.
What Are the Legal Duties of Your Riverside Health Insurance Company?
You may be unsure of the legal duties of your health insurance company. Your health insurance company is responsible for communicating all necessary information regarding your policy and investigating, processing, and paying claims. Even when an insurance company denies a claim, it must deal fairly and in good faith with each member.
Good faith means the company adheres to promises made when you signed up for health insurance. Your insurance company has a responsibility to respond to a claim within a reasonable amount of time and may not deny a claim without following the standard procedures related to investigating the procedure or service.
If your claim is denied, your health insurance company must provide a valid reason for the denial (services not covered under your policy, a procedure that is considered experimental, etc.). If your claim is denied, you have the right to appeal the decision—and your insurance company must provide policyholders with information regarding an appeal. In short, your insurance company has the following legal duties:
- A duty to defend
- A duty to indemnify
- The duty of good faith and fair dealing
- A duty to quickly and fairly manage claims
- The duty to settle within policy limits
- The duty to disclose conflicts
Why Are Riverside Health Insurance Claims Denied?
There are several reasons your health insurance company could deny your claim, including the following:
- You chose an out-of-network provider without prior authorization.
- A procedure was performed without prior authorization.
- Your doctor wants to perform a procedure that is currently considered experimental, unnecessary, investigational, or cosmetic.
- The services or procedures are not covered under your insurance policy.
- There was a mix-up or paperwork error that triggered a denial.
- Your insurance company wants you to try a different (less expensive) option first, then if that does not work, the company may pay for the requested service.
Any of the above reasons could be valid when a claim denial is made, and there could be others, depending on the circumstances. While these reasons are generally valid, there are more that might not be. The insurance company must provide a reason for denying your claim within a reasonable amount of time. If you feel the denial was not justified, there is an appeals process. Because these are complex matters, it can be highly beneficial to have Attorney Scott Glovsky on your side to fight for your rights, health, and future.
What Tactics Do Health Insurance Companies Often Use To Deny Claims?
Typically, insurance companies use “deny, delay, and underpay” tactics to convince you to give up. Once you give up, they have essentially “won,” and you will either pay for the service or procedure yourself (not an option for most) or do without a potentially life-changing or even life-saving treatment or procedure. Aside from valid denials, insurance companies are well-known for denials that are less than reasonable.
Because insurance companies are most interested in their financial bottom line, they may come up with one excuse after another for denying your claim. When you need the insurance you paid for desperately, your insurance company may delay paying for the procedure, service, or treatment time after time—to the point where many people will simply give up. Your insurance company may claim it never received the proper paperwork or may claim it is waiting for an evaluation from a medical professional.
Attorney Scott Glovsky will never give up on you, and if there is even a single shred of hope, he will fight for your approval. Finally, insurance companies will underpay claims any time they feel they can get away with it. If you have already been through the deny and delay stages, you may accept the underpayment simply because you are exhausted and believe something is better than nothing.
Examples of underpayment could be an offer for partial reimbursement or an offer to pay for a lower-cost procedure or treatment. Insurance companies underpay claims because they can—Scott Glovsky will stop them in their tracks, bringing justice to you. When your health insurance company breaches your insurance contract or acts in bad faith, resulting in damages to you, you have the right to sue your insurer to recover those damages.
How Can It Make a Difference in Your Case if You Hire a Riverside Health Insurance Denial Attorney?
If your health insurance company is acting in bad faith by delaying, denying, or underpaying your claim, the Law Offices of Scott Glovsky is standing by to help. As a highly experienced Riverside health insurance denial attorney, Scott Glovsky will aggressively stand up to your insurance company, forcing it to do what is right—and what you need for your health or the health of a family member. Denials, delays, and underpayments are not only an injustice; in some cases, your insurer is breaking the law. Contact the Law Offices of Scott Glovsky today for assistance with your health insurance denial, delay, or underpayment.
