As long as health insurance is concerned, the insurer shouldn’t give more priority to his profits than your health. When you have a health insurance policy, you depend on the insurance company for covering tests, appointments, and processes that are important for your wellbeing and health. However, it is sad enough to note that there are times when health insurance claims are unjustly denied. During such claim denials, patients are left with the obligation of bearing sky-high medical bills.
If you’ve been subject to claim denials, you must be wondering what your options are. Well, while it is true that a personal injury attorney can help navigate the case with your insurer, you should also remain aware of the steps that you need to take.
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Enquire about the reasons for denying health insurance
If the health insurance company denies you coverage, it is liable to offer the client a written explanation where he states the reason for denying you coverage. Why did he deny the client’s claim for the medical process, the treatment, testing process, or other medical services? Some of the common reasons why insurance companies deny claims are:
- Finding out that the care was not required
- Lack of authorization of treatment, death of pre-certification
- Being too late to file a claim or seeking the help of a doctor that is out of network
- A declaration that the treatment was done as an experiment
How are you supposed to fight a claim denial?
You are supposed to file a written personal injury appeal of the denied claim. Most of the time, you should exhaust the appeals process of your health plan before you file an injury lawsuit. Your plan will have definite time limits for submitting the appeal that varies from one plan to another. Hence you have to be watchful about your appeal deadline. In case you fail to appeal on time, this could keep you from filing a lawsuit.
Is it important to go for an external review?
You will be entitled to a free and external review if the health plan offers such a review. This is usually created by IRO or an Independent Review Organization. The IRO offers you a chance to have your claim approved. The IRO can even reach a similar decision of denying your claim. But the courts can view this decision as credible based on the fact that IRO is an independent organization. An expert healthcare lawyer will guide you through the entire process.
Should the insurance company be sued for claim denial?
Yes, in case you have a health insurance plan, you are supposed to respond immediately to a claim denial by filing a lawsuit. When the insurer defends its denial in spite of the appeal, you should file the lawsuit in no time. Just ensure you file the lawsuit within the right time.
So, if your health insurance company denies your claim, you should either take steps on your own or hire a claim denial lawyer.