You’re a prudent person who has been around the proverbial block once or twice with insurers, so you take care to follow through carefully on formal rules and processes relevant to approval before getting an advised surgery.
Your operation goes smoothly, with your post-surgical mood buoyed even further by knowledge that your surgery was signed off on and fully covered by your health insurance provider.
And then your life is turned upside down, commensurate with a letter received weeks later informing you that – guess what – the insurer has unilaterally reversed its position on your claim. It won’t be paying on it after all. You are stuck with the tab.
That’s a horrifying hypothetical, right? Luckily, such a thing never occurs in Oklahoma or anywhere else in the United States.
But wait a moment. It does. One national carrier was recently slapped by a state’s insurance regulator with millions of dollars in fines for what a recent article termed “systemic violations of the denial of claims.” Amassed empirical evidence shows that insurers routinely play such a game, with obviously life-upending results for insured individuals and families that relied in good faith on their assurances of coverage.
The bottom line with such denials is that policyholders who passively surrender to such conduct flatly lose the game played so well by insurers and suffer egregious losses in the process. A recent report from the Kaiser Family Foundation reveals that consumers almost never appeal insurance company denials.
They should. Here’s a revealing statistic: When they do, more than 60% of them reportedly prevail and have denials reversed.
A patients’ advocate penning an article on coverage denials and appeals underscores the salutary results that often ensue for denied policyholders who fight back rather than quietly surrender to insurance companies. She states that, “No one should take their health plan’s denial as arbitrary and final.”
An individual with an insurance-linked grievance can take proactive and empowered action by consulting with a proven legal team of pro-policyholders’ insurance law attorneys.