Health Insurance Lawyers
The Health Insurance Claim Crisis
The realm of healthcare insurance can be a complex landscape, particularly in light of the global health crises we have recently faced.
While we all aspire to believe that the healthcare system operates with the best interests of patients at heart, the reality is often very different.
Healthcare claim disputes come in many forms. For instance, a client may encounter the denial of crucial cancer treatment on the grounds of it being deemed “experimental.” Alternatively, a client may find themselves navigating the challenging situation of a family member in need of inpatient residential treatment for mental health or addiction, only for the insurance company to assert that the treatment is “not medically necessary.” These cases not only present emotional difficulties, but can also place a significant financial burden on families.
Why Was Your Healthcare Claim Denied?
Next Step - It's Time For An Appeal
Should You Consider An External Review?
Was Your Healthcare Claim Denied?
Denials of healthcare insurance claims occur for a multitude of reasons, and it is unfortunate that those who require and deserve healthcare the most often bear the brunt of these unfair practices.
Consider a situation where you are informed that your healthcare insurance claim was denied due to failure to obtain pre-authorization or because the healthcare provider you visited falls outside the approved network.
Such denials can have significant consequences, impacting your access to necessary medical treatment and potentially jeopardizing your well-being. It is essential to recognize that you have rights as an insured individual, and you should not face unnecessary barriers when seeking the care you need.
Filing An Appeal
When your healthcare claim is unjustly denied, it can be an incredibly disheartening experience. Dealing with injuries or illnesses already takes a toll on our emotional well-being, and being denied necessary care or financial support during such challenging times only makes everything more difficult.
However, it’s crucial to remember that you have rights, including the right to appeal the decision made by your healthcare insurance provider if you believe they have made an incorrect judgment. Some organizations may try to downplay or discourage your appeal rights, but it’s important not to let them discourage you.
We understand that the appeal process can feel overwhelming, but that’s where we step in to assist you. Navigating the intricacies of the appeal process is essential for preserving and strengthening your healthcare claim, and it must be handled with care, as mandated by the law. Typically, you have a timeframe of six months to gather the necessary information and file an appeal with your health insurer. Our aim is to simplify this process and allow you to focus on what matters most—your health and that of your family members.
The first step in successfully challenging a denial of healthcare insurance coverage is understanding that you are not alone.
requesting an External Review
If your appeal against your healthcare insurance provider proves unsuccessful, it’s important to know that you still have other legal options. One option is to request an external review through an Independent Review Organization (IRO). While the intent of an IRO is to provide an impartial assessment of your rights to a healthcare insurance claim, in reality, the success rate of the IRO route is often limited. As a result, challenging your healthcare insurance company’s denial of coverage in a court of law frequently offers more advantageous prospects.
When you choose to challenge the denial of coverage in a court of law, you gain the opportunity to present your case before a judge who can evaluate the facts and evidence with impartiality. This legal recourse allows for a comprehensive examination of the situation, ensuring that your rights and interests are diligently safeguarded.
Pursuing a Lawsuit
When facing a healthcare insurance claim denial, seeking guidance from an experienced attorney can be very valuable. They can help you understand the legal rights available to you, chart the most effective course of action, and assess the potential success of your case based on your individual circumstances.
A skilled attorney will thoroughly evaluate your claim by analyzing relevant case law, statutes, and government regulations, including the Mental Health Parity and Addiction Equity Act. This comprehensive assessment enables them to provide you with an accurate analysis of your situation and offer informed advice on how to proceed.
Our health insurance claim lawyers Can Help You
When facing a healthcare insurance denial, it’s essential to recognize that you are not alone in your struggle. At J. J. Conway Law, we have dedicated nearly 25 years to advocating for individuals, fighting for their legal rights. We have taken on the healthcare insurance industry on numerous occasions, and we are ready to stand by your side to rectify the situation and secure the benefits you have rightfully earned.
Our experienced team understands the complexities of healthcare insurance law and the tactics often employed by insurance companies to deny claims. We are committed to providing you with comprehensive legal representation tailored to your unique circumstances. By working together, we will develop a strategic approach to challenge the denial and pursue a favorable outcome.
Your healthcare insurance rights matter, and we are here to fight for them. Call us today, fill out our form, or visit our office in Royal Oak, Michigan and take the first step towards securing the benefits and care you are entitled to.
Contact Us
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.