It can be extremely depressing, even demoralizing to find out that the insurance company you have been paying monthly premiums to for months, years, or even decades has denied a treatment your doctor believes you need. You may have rarely even used your insurance over the years, but now you have a serious illness or injury, and your insurer does not want to pay for your treatment.
It feels like a betrayal of trust – and it is. Being denied coverage for a necessary medical treatment does not have to be the end of the story. You do not have to simply accept the decision of your insurer. This is a time when having an experienced Stockton health insurance denial attorney from the Law Offices of Scott Glovsky can make a real difference in the outcome of your denial.
Why Are Health Insurance Claims Denied?
A December 2024 CBS news story stated that many insurers are now denying one in five claims. This leaves American families paying more for coverage while getting less in return. Anger against healthcare insurance companies is boiling over, likely rooted in fears that necessary medical costs could ruin a family financially. When you consider that the top cause of bankruptcies is now medical debt, these fears are not so far off.
A health insurance claim can be denied for a variety of legitimate reasons. Perhaps the paperwork was incomplete, there were coding or other errors that can be fixed, a specific deadline was missed, there was no prior authorization as required, or you used an out-of-network provider. Some of these issues can be fixed, and the claim resubmitted, while others cannot.
If your Stockton, California health insurance denial has words like “not medically necessary,” “investigational,” or “experimental,” it is at least likely that the treatment is being denied because of the cost. Insurance companies are too often highly concerned about their financial bottom line, so the more claims they deny, the better for the company and its shareholders. Unfortunately, a company that makes billions in profits has too little positive impact on the actual people who pay for insurance and depend on it in their time of need.
What Can You Do if You Receive a Stockton, California Health Insurance Denial?
If you have received a Stockton health insurance denial from your insurer, now is not the time to give up. You do have options. First, you can file an internal appeal that asks your insurer to take a second look at the claim. Perhaps you have corrected any errors, attached any necessary documentation, or included a letter from your doctor stating the importance of the denied treatment for your health and future.
Your insurer may now approve the claim or continue to deny it. If the insurer denies the claim, you can file an external appeal with a neutral third party. Your insurance documents should include the process and time frames for internal and external appeals. Although you can file these appeals on your own, insurers generally take you much more seriously when you are working with an attorney to help you do so correctly. Once an attorney is involved, you are likely to be treated with much more respect than you would be on your own.
Which Insurers are Most Likely to Deny Treatments?
Any insurance company may deny claims – and many of them do so routinely. If there are any potential “loopholes” in the fine print of your insurance documents, you can count on your insurer using them to its advantage. While any of the following California insurers may deny claims, some tend to be more likely to do so than others.
Can You Sue a Health Insurance Company for Denying Your Claim?
The state of California has laws that are meant to protect consumers from insurance companies who routinely deny claims that should be paid. With certain types of health plans, if your claim for a service crucial to your health is denied, you can sue your insurer. If your health insurer has failed to meet its legal obligations under the terms of your insurance policy, you can file a bad faith lawsuit. Wrongful claim denials, deliberately slow payment of claims, or failure to pay valid claims can all be instances of bad faith on the part of your insurer.
Contact a Stockton Health Insurance Claim Denial Attorney from the Law Offices of Scott Glovsky
If your insurer has denied a legitimate claim, now is the time to take action. There are time limits associated with how long you have to file internal and external appeals, and the last thing you want to do is miss a deadline. Attorney Scott Glovsky has been helping people who face the untenable situation of a denied claim for necessary medical treatment for over twenty five years.
Scott and his legal team deliberately take fewer clients so they can give every case the time and care it deserves. Attorney Scott Glovsky has made it his mission to ensure clients are not taken advantage of. Scott will take on an act of bad faith by an insurance company, forcing the company to fulfill its promises to you. Take a look at the successes of the Law Offices of Scott Glovsky. Once you do, you will know you have chosen the right attorney for your Stockton health insurance claim denial. Contact us today for an assessment of your case.