Avoiding Bad Faith Health Insurance Claim Denials

Have you ever received an explanation of benefits notice from your insurance company and what you thought would be covered under your medical insurance policy is not? Now you are hit with out of pocket medical costs you did not expect. Here are a few things you can do to make sure you bullet proof your claim to avoid a denial.

First, make sure you understand exactly what is covered and what isn’t covered in your policy. Read your handbook, policy or certificate and if you have questions, write them down and call your agent or a top insurance attorney for clarification. Second, when you request pre-authorization make sure you fill out the forms correctly and provide all documentation that is required by the insurer. Missing data will assure your request for pre-authorization is returned to you and could cause you to be delayed timely treatment or denied benefits.

Third, make sure you keep good records. Keep records of the dates and times you had phone conversations with your insurance company and the name of the person you spoke to. Make copies of all paperwork submitted and all letters and other communications you have sent to your insurer. This documentation could come in very handy should you need to pursue a wrongful denial in court.

Appealing an Insurance Denial

Okay, you’ve done everything you can do on your end and you find yourself wrongfully denied, your first step is to get the assistance of a well-qualified health insurance attorney. Do not try to tackle the insurance company on your own; they hope that’s what you’re thinking. A top insurance attorney can help you work with your doctor to build your case, showing that the treatment you desire or have already received is necessary for your continued health and appropriate for your condition.

It is important that you act quickly as the appeals process with most insurance companies is time sensitive. The actual length of time you have to appeal will be outlined in your denial letter or stuck somewhere in your policy or certificate or booklet and could be anywhere from 30 – 180 days. A top insurance attorney will be able to quickly navigate your appeal through either internal or external appeals processes without snags that can occur because of inexperience or unfamiliarity. A top insurance attorney will be able to interpret you’re policy and get to the bottom of the denial mystery. A top insurance attorney will understand state regulations and federal mandates that govern your insurance company. Top insurance attorneys have taken other clients just like you through the appeal insurance denial process many times and know what to look out for and what to avoid.