Hiring a health insurance denial attorney can be a difficult process when you have never done it before. Therefore, in the following sections, we will cover reasons for health insurance denial, things to consider when hiring an attorney, and the advantages of having a health insurance denial attorney on your side.
First, we will start from the beginning with the question, why did you get a health insurance policy? The answer is pretty simple without even thinking about it; to mitigate the financial burden that comes with health costs in case of an emergency. Nobody knows when they can fall ill, what’s more, accidents occur and they cannot be foretold. It is insuch circumstances that see your financial status receiving quite a punch especially if you do not have health insurance coverage.
Health insurance benefits precede the costs such as premiums payable. However, you may not get to enjoy the benefits when you most need them. This is because, though your insurer wishes to support you through the hard times, they are also in it to make a profit. If the insurance companies paid every claim, therefore, they would be making lesser profits.
That leads us to the question of the day, and one of the most worrying situations that you could not wish for any person. That is health insurance denial! Insurance companies employ all they can to ensure that claims do not go through. When dealing with health insurance, here are some of the reasons your policy may get slammed.
Why Did Your Insurance Claim Get Denied?
Most instances, you will get an explanation on why your claim did not go through. Some of the most common reasons are:
The Treatment Was Not A Necessary Procedure
A quick visit to the hospital may be prompted by, for instance, an achy belly. When you get to the hospital, however, your doctor, who has the responsibility to ensure that you get comprehensive health care, determines that a particular procedure is needed to cater to your situation.
Your insurer may not see such situations that way; instead, they may deem such procedures unnecessary thus denying your claim.
The Treatment Is Only in Experimental Stages
The health industry is one of the most versatile sectors, owing to growing health demands. As such, there is always something new in the market to deal with various ailments. When you go for a treatment, you may be treated following a new procedure but whose legality is proven. However, your insurance provider may deny your claim stating that you were a subject of trial medication.
Your Policy Does Not Include Such A Treatment
The other shot that insurance providers like to exploit is using the fine print to deny your claim. Having signed all the legal documents as you procured the policy, you are in agreement with your health insurance provider. However, that agreement is bound by the terms and conditions of the policy.
If you did not understand the fine print, this is one of the most effective channels to deny your claim. However, with the help of an experienced health insurance denial attorney, you will be able to determine whether the insurance company is following the legal route or simply looking for a loophole to deny your hard-earned medical benefits.
Finding A Preexisting Condition to Link the Medical Problem to Avoid Paying the Claim
As you purchase a health insurance policy, insurance companies consider concepts such as medical history and age to determine your premiums. Nonetheless, when you fall ill and file a claim, they may try to twist your illness to their advantage. This is by associating your current ailment with a preexisting condition as a basis of denying your claim. A health insurance denial attorney in collaboration of a professional medical practitioner comes in handy at such instances to appeal the insurance decision and get your benefits.
Well, your claim might be honored, eventually, after a prolonged delay. Insurance companies may come up with unreasonable reasons to deny your claim all in bad faith. Remember their primary goal is to maximize their profits. As such, bad faith, coupled with some clever trickery might go a long way in ensuring that their health insurance holders do not get paid.
That is one of the primary reasons you should not take the first no from your health insurance provider. Appeal their decision and employ professional services of a health insurance denial attorney to ensure you get what you deserve.
Hiring a Health Insurance Denial Attorney
A health insurance denial claim lawyer can help you claim proper compensation. An experienced attorney will challenge the decision made and get you the medical financial aid you require. As a consumer, you have rights which must be respected as provided for in the law and the constitution. Insurers often look for small issues or excuses to render your claims null and void. That is why you have to find a reliable health insurance denial lawyer near you to help you fight for your rightful claims.
Why Get an Attorney for Health Insurance Denial?
When you have exhausted all the avenues, you must think outside the box not forgetting that you cannot make an external appeal without an attorney. Moreover, health insurance denial attorneys are cut out for these kinds of things. Their duty is to you and your needs which have been given a backseat by the insurer.
Negotiation is also a skill in which not every one of us possesses but the attorneys are trained and do such kind of work on a regular basis. Someone with the right knowledge of the system can lead you to what you need most. Here is why you need to consider hiring a health insurance denial attorney.
Advantages of Hiring a Health Insurance Denial Attorney
You can rest assured that you will go home with the best deal possible when you hire an experienced attorney. Where your claim is in bad faith, for instance, your insurer may recognize your winning potential and come up with an enticing offer to let you off.
A health insurance attorney, with the expertise and information, gathered throughout the case, can quickly establish such instances and ensure that you only settle for the best. You can get compensation not only for the denied benefits but also time wasted and fees incurred in the process of such a situation.
At times we need someone to guide us on what to do when in some situations. A lawyer will be able to guide you through the process of securing your rights, let you know how an appeal is filled, and guide you through the process.
You may drag on waiting to appeal, and after the stipulated time lapses, it will be difficult to challenge the decision of the company. Keeping in mind that you are healing from your ailment, keeping up with the challenging and new concepts of filling an appeal adds more troubles in your life. Relax, concentrate on healing, and let the professionals do their job for you.
Proper Investigation and Evidence Collection
When you petition on your own, you may miss a lot of essential facts. An attorney has the time and resources needed to prepare the right documentation for a successful appeal. They have all the skills to build a reasonable and concrete case to appeal your denial, giving you an edge noting that you are dealing with a giant that is insurance company working to take away your benefits.
Representation in Court
You may end up suing your insurer by the end of the day. An attorney deals with courtrooms and is aware of the mechanism involved in courtrooms more than you do. That means they will represent you adequately to ensure that your case is presented in the best way possible.
Court proceedings can take time, and with an attorney, such worries are lifted off your shoulders. Keeping up with a prolonged case can also demoralize your quest, but with the constant care of a health insurance denial attorney, your case will go to the end.
Finding a Health Insurance Denial Attorney Nearby
The internet has revolutionized every concept in our lives. Today, it is easier to find a health insurance denial attorney. All you need to do is to use a phrase such as 'health insurance denial attorney near me’ and the search engine will give you an overview of who is available in your area.
It is advisable to settle foran attorney within your area as they are well versed with the laws within your jurisdiction. Find an attorney that you can trust and whose expertise and experience gives you an edge for the appeal. While determining how good an attorney is, check out the reviews on their sites. Also, consider the cases they have had before and do not forget to check whether they are legally operating by ensuring their firm is registered.
Appealing an Insurance Company Decision
When you have been cornered, and you are in dire need, NO is never an option. It is time to appeal and there are two standard appeal options:
- Internal request. You can ask the insurance company to revisit their decision that leads to their conclusion. That may not always yield the intended results, but it may save you the time if it goes your way.
- External appeal. The external appeal is whereby you take your grievances to a third party. In such a scenario, you not only consider a health insurance attorney as a necessity but also their expertise comes in handy to ensure that you get the best out of the appeal.
The Process of Making an Appeal
Your attorney will devise a suitable plan to appeal your denial. You do not have to worry about the process as the attorney will guide you and advice all through. Here is how the appeal process takes place.
Review the Health Plan Documents
The first step that you need to take is to go through the insurance paperwork. The documents that you signed when getting the health insurance policy will be of great use. You have to study them and find anything that you may have been the source of the denial.
Understanding the fine print goes a long way in ensuring that you get what you have been paying premiums for. With the help of a health insurance denial attorney, you can spot the loopholes that an insurance firm is likely to use in denying your claim.
Get All Your Application Documents
The next step is going through the file that you used to make the claim. The data will be handy to prove whether you left something out when making a claim. Noting that insurance companies will utilize any reason to their advantage, even a misspelled name could have been the reason for your denial. Revisit the documents and thoroughly check for any discrepancies to ensure they are in agreement with your policy.
Get the Doctor to Recommend Treatment
Suppose the rejection of your application was due to an allegation that you have a preexisting condition; a doctor can help prove otherwise. The doctor can help get you more information on the disease and even offer some sources that you can cite for argument.
Where the denial is a result of your treatment being deemed as unnecessary, you also need your doctor to help you enlighten the insurance firm on the consequences if you were not subjected to the procedure.
Keep All the Conversations Recorded
Recording conversation can help you with evidence when you need one. Ensure that you have the name of the insurance agent you talked to on the phone on record to make the recordings viable evidence.
You need all the proof you can gather to ease your appeal and give you the upper hand. The good thing is, with the help of your health insurance denial attorney, you can collect more proof by spotting some of the things that you may have ignored as you considered what is necessary for your appeal.
File the Appeal
There is a set deadline for an appeal to be filed after your claim is denied. Submitting the appeal is a significant step to getting what you deserve. The petition may be heard or rejected after a few days. However, that is not the end of the road for you. You have to keep a copy of the appeal file just in case you fail to get compensation. You can produce the record as evidence in the court of law.
Keep Following up on the Process
The appeal process may take longer depending on the insurance company and the reasons your claim was denied. You may lose hope in between, but with the help of your health insurance denial attorney, your worries are in the right hands.
Take note that the process may be dragging along purposely to derail the payment. Keep up with the process; your attorney will give you regular updates and offer insight into what to expect from the proceedings.
External Appeal for Health Insurance Denied a Claim
When the internal appeal bears no fruits, it is time to consider an external appeal. Let your health insurance denial attorney find all the faults in the laws and the practices where the system is failing you to get the justice you deserve within a short time. A health insurance denial attorney will study your case and come up with an argument that will challenge the Company’s decision to refuse your claim.
In the case of an external appeal, your insurance provider does not hold the final say. You are taking everything to a whole new level. With a health insurance denial by your side, you can speed up the process by eliminating the smaller matters fast, ensuring that your records are well organized, as well as identifying why your claim was denied.
Though an external appeal may take longer than desired, your attorney will advise you on whether your case holds merit. If it does, then you need to bear with the situation and hold your position. Do not let the insurance company intimidate you, their objective is to take away your benefits, but your goals are well over that; you want your rights respected and get the compensation you deserve; after all, it is your sweat, and you deserve its fruits.
Dealing with an ailment is challenging enough, adding the trouble of dealing with an insurance firm makes it worse. Hire an experienced health insurance denial attorney to take care of your denied health insurance claims and focus on getting well.
Find a Health Insurance Denial Attorney Near Me
Finding health insurance appeal help near you is now easier than before. Stop Health Insurance Denial is here to ensure you get the best services. We will be with you through the difficult moments to ensure you not only get the best compensation possible but also allow you to enjoy speedy recovery as we take the trouble of your shoulders. Equipped with the right skills and experience, we not only take your case but also make it our priority. We have enough resources to allocate more than enough time to your case ensuring we do not miss a thing.
Give us a call at 310-695-5241 for any inquiries you may have regarding health insurance denial and the process of hiring an attorney. We are more than happy to offer consultancy services to ensure you understand what your situation means and the best approach to handle it. If you or your loved one happens to be in such a perilous situation, do not take the easy way out; you deserve proper compensation for the health insurance benefits you have been paying premiums for.
Do not take a simple “NO” for an answer, let us help you get what you deserve and stop health insurance denial from breaking your bank.