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Addressing a health insurance denial for mental health coverage

On Behalf of | Oct 8, 2020 | Firm News

Having health coverage in Oklahoma is a protective device for people who are suffering from a medical issue. A common concern, however, is what to do if there is a denial of coverage. For those suffering from a condition that is harder to diagnose and may not be visible to the naked eye, there may be fear that the insurer will determine that it does not really exist and therefore does not warrant payment.

This is a frequent challenge for those who are suffering from mental health problems. Understanding the basics in the state is essential. So too is it wise to have legal assistance if the insurer does not follow the law.

Common challenges with health insurance and mental illness

Under federal law, there is the requirement that “parity” is in place equating mental health with other health conditions. This applies to health care coverage provided by insurers, coverage purchased through an exchange, CHIP, and most Medicaid programs. The policy should state its requirements and coverage for mental health. When there is a denial, there must be a reason. Disputing that denial is always and option and it is wise to know what to do.

Insurers are known to deny claims if the person needed residential treatment; required hospitalization, intensive treatment on an outpatient basis or psychological rehabilitation; or needed office diagnostic care. The insurer might also violate the parity law. Signs of this include mental health treatment costing more than other levels of care; needing to call to get the care approved when it is not necessary for other types of treatment; a denial due to it being categorized as not medically necessary; problems finding providers who are accepting new patients; and the plan refusing to cover people who need residential mental health treatment while it covers other health issues.

Having legal help may be beneficial to receive insurance payments

The perception that insurance companies are more than willing to collect the premiums from clients but will then do whatever they can to avoid paying when care is needed might sound like paranoia, but it happens all too often. Insurers might do whatever they can to deny a claim regardless of its validity and it being covered under the policy.

Those confronted with this type of behavior should be aware of their rights. A law firm that specializes in health insurance claims and getting clients what they are entitled to should be contacted immediately to address the denial and seek payment.