Mansell, Engel & Cole

Focus: insurance company denials in the medical realm

Many of the problems faced by insured policyholders when they seek to collect on a bona-fide claim are similarly suffered by hospitals and other care providers on a more writ-large basis.

That is, hospitals and other care-delivery entities in Oklahoma and across the country routinely encounter the same frustrations that individual policyholders do, ranging from purposeful insurance company acts that delay or underpay claims to refusals to defend and outright coverage denial.

When looked at from a medical industry perspective, the problems stemming from insurance denial are of an extreme large magnitude. To some, they might reasonably seem to be staggering beyond belief.

Here's a relevant -- and candidly eye-popping -- statistic: Reportedly, and as noted in a recent media focus on insurance claim denials, "Hospitals across the country lose approximately $262 billion per year on denied claims from insurers."

Looked at another way, initial denial of hospital payment demands subjects hospitals on a per-capita basis (that is, an "average" American facility) to approximately $5 million in at-risk money.

And it would likely surprise few people to know that getting that money back -- the term "claw back" is a frequent denotation in the denied-insurance context -- is an often arduous task. In many instances, administrators spend considerable amounts of time and money getting what was rightfully theirs in the first place.

Claim denial, delay and underpayment are all common responses issuing from insurers under a contractual duty to perform in a timely and good-faith manner.

When an insurer refuses to respond as it should in a policy-related matter, an insured might reasonably want to secure the prompt assistance of a proven insurance law firm that is exclusively devoted to promoting the legal rights and interests of policyholders.

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