Health insurance providers are known to act with intentional slowness when it comes to processing insurance claims. Whether it’s a medical coding error or a pre-authorization requirement, insurance claim delay is more than just mere annoyance. After all, it’s not uncommon for an insurance company to say they will not cover a procedure, service, or test ordered by the doctor. Most people also submit a claim to the insurer for a procedure or treatment they paid for out-of-pocket only for them to wait for months on end to be reimbursed. The problem is that delayed payment of insurance benefits is no longer a run-of-the-mill inconvenience. They have turned into an issue of consumer financial security as the cost of healthcare grows more exorbitant.

Health insurers spent a great deal of time and resources training their staff and investigators to highly scrutinize claims. They often employ unfair tactics to delay claims and take advantage of unrepresented claims. They also employ a team of in-house attorneys to aggressively defend lawsuits brought against them. Facing your health insurer without legal counsel and representation may limit your ability to overcome such resources.

Health Insurance Companies Notorious for Slow Walking

Health insurance companies have a duty to process and pay all valid claims in a prompt manner. Unfortunately, having health insurance also means dealing with confusing and complex reimbursement requirements, inefficient payment systems, and overworked health insurance employees. Most claimants don’t really have the time or patience to wrangle with the insurance carrier over valid payment. Consumers who have to keep up with insurance providers dragging their feet begin to question why they pay their premiums in the first place.

The sad truth is that insurers employ a tactic called slow walking in order to avoid paying valid claims. And when they do this, they expect that the claimant won’t fight back. It’s even sadder that many claimants just accept the decision made by the insurance carrier that outnumbers them in resources because of their disability or illness. Some even die before they receive the benefits they’re entitled to because their insurer took them in eternal rounds without taking any positive steps.

If you feel that your health insurer is unreasonably delaying your benefits, contact Stop Health Insurance Denial today at 310-695-5241 to discuss your legal need s and find out how we can help you in a free consultation.

Understanding Common Tactics Employed by Health Insurance Companies

Insurance companies often use aggressive and often confusing strategies as part of their unfair claims handling process to manipulate policyholders and their healthcare providers into making statements that can be easily misinterpreted and used to prove the reason for delayed benefits. The insurance provider’s interest in the initial application and throughout the claims process is to minimize payouts as much as they can. In most cases, their interests are better protected than the rights of the insured.  If your benefits have been delayed, it’s important that you discuss your legal options with an experienced attorney who understands the tactics that insurance companies use to delay valid claims.

Requesting for Duplicative and Seemingly Unnecessary Information

Usually, an insurer will require the policyholder’s treating doctor to complete an Attending Physician Statement. Many times the insurer will contact the doctor in order to discuss the health condition of a claimant. Many of our clients have actually complained that their treating physician was asked very limited and pointed questions in an interview with the insurer, and without an opportunity to fully explain the claimant’s condition.

Then after this, the insurance company will start to delay payments of benefits by requesting additional information, which can be duplicative and sometimes not necessary. The insurer will go ahead and claim that it is unable to approve your claim for health insurance benefits without the additional information. While you, as a claimant, have an obligation to prove your claim by providing supportive documents, you must understand that insurance carriers are not automatically entitled to everything they ask for. They only entitled to relevant information directly related to the claim.

At Stop Health Insurance Denial we consult with our client’s treating physicians to ensure that they know the most important information to provide the insurance company with. Furthermore, it’s important that the treating doctor knows the misleading questions so they can be in a better position to ensure that the claimant’s condition is understood.

Request for Information

Despite the fact it’s your duty as the claimant to provide sufficient evidence to demonstrate your claim, you must be informed that insurance providers aren’t entitled to everything that the request for. They only entitled to relevant information to the claim of disability.  To avoid providing irrelevant information that could be used unjustly to obscure your claim, it is important for you to understand the legal effects of the documents your insurer is requesting for.

Conducting Field Interviews

Health insurance providers typically require telephone or in-person interview with a policyholder early on in the claim process. The insurance agents are comprehensively trained in how to frame questions that will elicit more information that can be taken out of context or misconstrued later in the claim process.  A policyholder can also be called in for more interviews. This tactic offers the insurer the necessary ammunition to delay benefits. We never allow our clients to attend an in-person or telephone without us being present.  Before any interview with the insurance providers, we fully prepare our clients for what they’re likely to face and limit the ability of the interviewer to ask abstruse and unfair questions.

Requesting an Independent Medical Examination Before Approving Treatment

Your insurance company may delay the payment of your insurance benefits by asking you to attend an independent medical examination. This is usually conducted by a healthcare provider chosen and paid for by the insurer. This medical examination simply means that you’ll have to wait for a significant amount of time before the results are out. Most insurance policies require claimants to submit such an examination at the discretion of their insurer, but restrictions do apply on the type of IME that’s requested.

The medical examination is more of a “second opinion” needed by the insurer before they can approve the treatment or procedure. This strategy delays pre-authorization approval by a couple of months. To begin with, the insurer spends a significant amount of time getting the medical examination scheduled. Then the insurer has to wait for a doctor’s report afterward. In addition, the insurance company will usually not agree to release the benefits if the second opinion doctor’s report state’s that you don’t need the treatment or procedure you need authorization for. This means that you experience more delay.

At Stop Health Insurance Denial, we carefully negotiate with the insurer about the appropriate physician, the scope of examination, the tests to be conducted, and the physician’s specialty before we can allow our clients to attend independent medical examinations. We also attend the examination or have it videotaped to make sure there’s no biasness. 

Lapse of Policy as a Result of Failure to Pay Premiums

When it comes a time when you have to file health insurance benefits, you may come to learn that premiums are unpaid or outstanding. But insurance companies tend not to acknowledge that the reason for unpaid premiums may be because the policyholder suffers a condition that affects the ability to remember to do things or the policyholder was forced to pay medical bills instead of premiums or became too ill too quickly and couldn’t keep up with the bills.

Because of these common reasons for outstanding payment of premiums, your insurer may be required to give you a certain period of time to pay the outstanding amount or may require a third-party designee to get notifications relating to missed payment of premiums.

The attorneys at Stop Health Insurance Denial will aggressively assert your rights to ensure your policy is reinstated and that you receive your benefits in a timely manner.

Asking for a Recorded Statement

It may seem reasonable for an insurance agent to ask you about your medical condition and request that you provide the information via a recorded statement. While you may think this is done in order to fairly compensate you, insurance agents typically use recorded statement to devalue and delay benefits. The information you give can be used against you later. Remember, the ultimate goal of your health insurer is to pay out as little as possible or completely nothing for claims. They will do anything to achieve this goal.

Failing to Return E-mails or Calls from the Treating Physician

Unfortunately, one of the biggest tactics that insurance companies employ to delay payment of health insurance benefits is simply not responding to request for pre-authorization. They don’t really say “No” to the healthcare provider. Instead, they just do nothing for weeks or months. And if the doctor requesting for authorization does not want to provide treatment without the insurer’s approval, it could mean that the claimant has to wait until the insurance company responds.

Video Surveillance

You may think that your insurer is delaying your benefits because they have a huge load of claims to handle, only to be shocked that they were actually conducting video surveillance the whole time without your knowledge. If, for instance, you have a debilitating condition, your insurer may hire a private investigator and conduct video surveillance. This strategy is typically employed to create the illusion that you’re less truthful based on how you answered questions asked during the field interview. As such, your insurer delays your claim as they find a reason to deny benefits or threaten you into accepting a settlement that is much lower than what you’re actually entitled to.

Surveillance videos are usually misleading and unreliable and therefore, you should know your rights before you can agree to any settlement. Insurance companies are usually able to trick claimants into accepting their denial or underpayment of their benefits without addressing the flaws in the surveillance videos. We, at Stop Health Insurance Denials, typically request a copy of the surveillance video and ask for a review from our client’s treating physician before any decision is made.

There are particular stages in the claims process that a claimant will be placed under surveillance by their insurance company. For this reason, it’s important to have an idea of when your insurer may use surveillance or how it’s done. This can be important to your claim or appeal.

Understanding these tactics as well as your rights and obligations as a claimant is crucial to maneuvering through the health insurance minefield. After all, what can improve your chance of successfully receiving benefits is your knowledge and the knowledge or your attorneys. We can guide you through all stages of the claims process and help you understand your rights and legal options. We review all forms submitted for information, prepare our clients for interviews with the insurer, and work with the clients’ treating doctors to help them understand the clients’ needs and the significance of properly documenting the patient’s condition.

Motives Behind Health Insurance Delays

While it can be easy to understand why an insurer would deny claims, can be harder to comprehend why they would drag their feet when it comes to paying claims. What could they be gaining from these delays? Let’s take a look:

  • Insurance delays help them collect more interest: Every single day your insurer delays payment is another day that the money you’re entitled to sits in their bank account generating interest.  While this may not sound like it would be that much, think of hundreds or thousands of delayed claims.
  • They’re retaliating against you:  If you’ve ever acted in a way that didn’t go well with your insurer or made a fuss on your social media page, it’s possible the delay could be for personal reasons. While this may seem inappropriate and immature, it’s not uncommon.
  • You insurer hopes their delay will force you to accept their low ball settlement: When a claim is delayed, a policyholder patient is left to wait until the claim is approved in order to receive treatment or undergo a procedure. For this reason, some health insurance carriers believe that delaying a claim payment will make you desperate enough to accept their offer and pay for your medical expenses.
  • Sit and wait: Insurance companies delay payments and take claimants in eternal turnarounds to increase the likelihood that a claimant would give up. The insurance company will cite reasons such as “the claim is too late,” “you filed the wrong paperwork,” or “you did not fill out the paperwork.” Insurance companies in most cases delay claims processing to try to avoid paying, knowing that the claimant will give up or even die.

Has Your Insurer Delayed Your Claim? Know Your Rights

  • Prompt pay laws

An insurer has the duty to promptly and fairly investigate claims and provide benefits for legitimate claims. Many states in the United States have prompt pay laws obligating health insurance carriers to pay claims within a definite period of time, usually 30 days. The rules governing delayed insurance benefits differ from one state to the other.

  • Insurance Companies Must Put the Interests of a Policyholder Ahead

Federal laws that govern insurance companies stipulate that health insurance providers cannot prioritize their own financial interests at the expense of policyholders. Physicians have always complained that insurance carriers delay the approval of benefits as a strategy intended to wear a patient down to the extent of giving up on their insurance claim.

When to File a Lawsuit

A delay in the payment of benefits is usually the prelude to the automatic denial of a valid claim. For this reason, it’s important to take action sooner rather than later if at all your insurer is stalling on the payment of a claim. If your insurer refuses to overturn a wrongful delay of benefits, the next step of the process is filing a lawsuit in court. Many people in your position often feel that they’re being stonewalled by their insurer and no matter what they do or what information they provide; the insurance company refuses to pay benefits.

Insurance delays involve highly complex legal issues and are often fiercely litigated. The law governing the claims is also constantly changing. If your insurance provider is refusing to pay benefits, you need an attorney who understands the process and is extensively experienced in litigating such claims.

Finding a Health Insurance Claim Delay Attorney Near Me

If you or a loved one has been injured or fallen ill, will you be able to collect full benefits under your policy to take care of medical expenses? Will your health insurer abide by the terms of your policy and approve payment of benefits? Your need for medical treatment or procedure does not stop if your insurer denies your claim.

The attorneys at Stop Health Insurance Denial represent clients throughout the United States in cases involving delays in the payment of insurance benefits. Our attorneys have earned a reputation as tenacious litigators and astute analysts of insurance disputes with skill and understanding of the law. We’re committed to aggressively assert the rights of our clients in and out of the courtroom. When you retain our services, we’ll work diligently to obtain the benefits you’re entitled to.

If you’re in financial distress due to delayed benefits or are in dire need of pre-authorization for treatment but your insurance provider is slow walking, we can help. Schedule a free and informative consultation with one of our experienced attorneys by calling 310-695-5241 or filling our online contact form.