When you pay a premium to a health insurance company, you will probably expect that the insurance provider will pay for your medical bills without a hassle. However, an insurance provider has the goal of making the smallest payouts possible. If you believe that your health insurance claim denial is not justified, you may need to involve a lawyer.
Finding Out Why Your Claim Was Denied
If you are wondering why your claim was denied, you should receive a written explanation from your insurance provider, as is required by law. You will need to file the appeal within a specific time limit.
To maximize the chances that your appeal will be accepted, make sure that any documents sent to you by your health insurance provider are given to your attorney. This will allow your attorney to prepare the best possible case.
How to Move Forward
You may want to contact customer service to have your claim denial explained to you. However, this can backfire because anything you say can be used against you to deny your claim.
In some cases, the health insurance provider may refuse to pay. For example, if you were injured in a car accident, they may expect you to seek compensation from your auto insurance provider. However, you will want to act quickly because there will be a time limit for you to file an appeal.
Based on your current health insurance policy, there will be some services that are covered and some services that are not covered. However, depending on the nature of the disease or injury, your attorney may be able to argue that your condition is closely related to a condition that is covered.
Bad Faith Claim Denials
If you believe that your claim was denied in bad faith, you will want to consider filing a lawsuit against the insurance provider. However, you will only want to do this after hearing the advice of an attorney because a lawsuit can be expensive and time-consuming.
Before filing a lawsuit against your health insurance provider, you will want to make sure that there is no other reason for the claim denial, such as incorrect information.
But even if there was a justified reason for why your claim was denied, your insurance provider might be acting in bad faith in another way. Some insurance providers delay the processing of your claim. Only an experienced attorney can help you overcome a case involving a bad faith insurance provider.
For more information, contact an insurance litigation attorney in your area.