Many people are disappointed when they seek out a Doctor recommended promising new treatment for their medical condition only to find out that their claim has been denied by their insurance company. Denials often result in patients having to pay tens of thousands of dollars out of pocket to obtain treatment, or more commonly not being able to get the treatment at all. This is simply because the insurance company does not want to pay the costs of the medical treatment. But when it comes to the health insurance industry, “no” does not always mean “no.”
Insurance companies are in the business of making money. They hope that when they deny your claim, you’ll simply accept their denial and move on. But it doesn’t have to be that way. If you take the time to appeal the claim, you’ll sometimes find that “no” can turn into a “yes.” In fact, the Government Accountability Office conducted a study and found that half of all claims are eventually approved.
Many health insurance denials are the result of missing information, billing errors and incorrect coding of conditions and/or treatments. Sometimes, even a simple phone call can remedy the situation. However, the majority of claims often require more legwork on your end because the decision is centered around whether or not the treatment is “medically necessary” or if the treatment has been deemed “experimental.”
As a first step, try to figure out what has caused the treatment denial. Call the insurance company to obtain as much information as possible. Request a copy of the denial letter. You will also need to know your plan’s benefits, often called Evidence of Coverage. If you do not have a copy of your plan’s coverage, request a copy from the insurer. Then send what you have to us.
Once you have this basic information, the next step is to file an appeal. Ask your doctor to submit an appeal on your behalf.
After the final appeal is denied by your insurance company, a complaint can be filed with the California Department of Insurance. Please also contact us immediately.
The Health Insurance Denial Attorneys of Nadrich & Cohen, LLP have decades of experience representing patients whose health insurance provider has denied coverage for treatment and/or procedures. Our lawyers work on a contingency fee basis which means that nothing is paid out of your pocket for our involvement. We only collect a fee if a recovery is made.