Oklahomans and people around the nation can face a health crisis or need various types of medical care without warning. Even with the recent global health emergency subsiding, people are still in need of care every day.
These challenges can be made worse by not getting the necessary care and being confronted by enormous medical expenses that people expected would be covered by their insurer. Those who have an insurance policy should be able to go and get medical care without thinking about it beforehand due to concerns about coverage and cost. For those who believe they were unfairly denied, there are legal options available to recover compensation for all that was lost.
Why might my claim have been denied?
There are many explanations an insurer might give for denying a claim. Once the treatment has been given and people find out they are not getting the insurance coverage they expected, they will be understandably worried and upset about the claim denial.
For some, they were denied before they had the treatment. This is a pre-authorization denial. With many medical treatments, the company must first approve it or deny it. The person has a right of appeal, but this takes time and those who need urgent care may not be able to wait.
Insurers might deny a claim because they did not have the proper paperwork to approve it. It might have been a mistake. They could question how it is medical necessary. Regarding necessity, they might claim that the person does not need the treatment; or they could say that even though it is necessary, their policy does not cover it.
Because insurers are trying to maximize profit and keep payouts to a minimum, they might encourage the policy holder to seek a less expensive alternative type of treatment. Regardless of the justification, the denial can not only damage a person physically, but it can be negative emotionally and, of course, financially.
Unfair health insurance denials should not be accepted
Having health insurance is a safety net. People frequently take certain jobs they otherwise might not have taken because it has excellent health insurance coverage. Others pay out of pocket for a policy to make sure they are protected if they or a loved one becomes ill. This planning can be undone simply because the insurance company decided to deny the claim.
Whether it is due to pre-authorization or for another reason, those who are facing the personal and financial aftermath of denied claims and disputes over health insurance need not deal with this challenge alone. Consulting with professionals whose specialty is handling these types of cases.
Because an insurance denial can leave people with massive bills they cannot pay, it is imperative that they do whatever they can to get the insurance coverage they paid for. Those who had a sudden injury, a heart attack, a stroke and other health challenges should be aware of this.
In the past several years, those who previously had no major health worries suddenly found themselves hospitalized and with long-term damage. Insurance companies should not be allowed to get away with not paying when they should pay. Contacting those who understand bad faith by insurers should be a first step.