Health Insurance Lawyers
Health Insurance Claim Crisis
The world of healthcare insurance can be a complex business – especially after the global health crises we have all endured in recent years.
As much as we all want to believe that the healthcare system functions with the best interests of its patients in mind, the reality is far different.
Healthcare claim litigation comes in many forms. A client may experience the denial of expensive cancer treatment on the grounds that it is “experimental.” Or a client may have a family member in need of inpatient residential treatment for mental healthcare or addiction, and the insurance company claims the treatment is ‘not medically necessary.’ These are emotionally difficult cases, but they can also take a family to the brink financially.
Why Was Your Healthcare Claim Denied?
Next Step - It's Time For An Appeal
Should You Consider An External Review?
Why Was Your Healthcare Claim Denied?
Healthcare insurance claims are denied for many reasons – and unfortunately, it’s often the people who need and deserve healthcare the most that are harmed by these improper practices.
For example, you could be told that you filed a healthcare insurance claim without seeking pre-authorization or that your healthcare insurance provider is outside of the approved provider network.
Next Step – It’s Time For An Appeal
If your healthcare claim has been denied, it can be disheartening – and understandably so. Injuries and illnesses are difficult enough to our emotional well-being as it is – being denied any medically necessary care or financial support during such a difficult time just makes everything even more difficult.
You do have rights, including the right to appeal against the decision made by your healthcare insurance provider if you believe they are wrong. Naturally, some unprincipled organizations may try to downplay your appeal rights or even dissuade you from taking action – don’t listen to them.
Making an appeal can be daunting, but that is where we can help. These are important aspects of preserving and perfecting your healthcare claim and – by law – they must be done carefully. Typically, you have six months to assemble an appeal and have it filed with the health insurer. We try to simplify the process and allow you to focus on what is most important – your health or that of your family members.
The first step in successfully challenging a denial of healthcare insurance coverage is understanding that you are not alone.
Should you request an External Review?
If an appeal against your healthcare insurance provider is unsuccessful, you have other legal options. One of these is to request an external review via an Independent Review Organization (IRO). Although the aim is to provide an impartial perspective on your rights to a healthcare insurance claim – in practice, the IRO route is rarely successful. Instead, there are often more advantages to challenging your healthcare insurance company’s denial of coverage to you in a court of law.
Should You Pursue a Lawsuit?
An experienced attorney can suggest what legal rights you have, how best to pursue them, and even evaluate your chances based on your unique circumstances. This involves evaluating the claim based on caselaw, statutes, and government regulations such as the Mental Health Parity and Addiction Equity Act.
How We Can Help You
The first step in successfully challenging a healthcare insurance denial is understanding that you are not alone.
At J. J. Conway Law, we have nearly 25 years of experience in fighting for the legal rights of people just like you. We regularly take on the healthcare insurance industry – and we want to work with you in putting things right and securing for you the benefits that you have earned.
Call us at 313-961-6525, contact us online, or visit our offices in Royal Oak, Michigan for a consultation today.
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Please note that by contacting our office you understand that this communication is for informational purposes only. Any legal representation by our office requires a signed written agreement establishing a lawyer-client relationship. Thank you, again, for contacting us.