Are you Dealing with Health Insurance Claim Denial? If you have a health insurance policy, you expect your medical bill to be paid by the insurance company. Nevertheless, in some cases, insurance companies or other health plans may deny valid claims and therefore refuse to cover the medical bill.
Common explanations for denying paying for medical treatment are that the treatment is not covered by the policy, or it was ‘experimental’ or that it was not medically right. In this post, you will learn how to sue a health insurance company when it refuses to cover your medical bill.
In the United States, employee benefits claims are usually governed by the Employee Retirement Income Security Act 1974 (ERISA), with few exceptions. And under ERISA, benefit claims an individual should first complete the internal appeals process before filing a lawsuit.
So, can an attorney help you with health insurance claim denial? The answer is yes. But before you consider bringing a lawsuit against your insurer, there are three processes you should follow first;
- A first internal review with the insurer
- A second internal review with the insurer
- An independent review or external review
If you are unsatisfied with the independent review outcome, you can sue the insurance company. However, to bring a formal lawsuit against your health insurer will depend on your state’s laws as well as your insurance plan. This is where you need a qualified attorney to give you advice.
Present the following documents to your attorney:
Table of Contents
- Your health policy
- A written record of communication between you and your insurer
- The denial documents from the insurance company
- Report from internal and external review processes
For you to have a strong chance of winning the case or earning a satisfactory settlement, you need to keep in mind a few key points, including:
- Your insurance provider may send back to you your premiums along with other documents. In this case, DO NOT put your initials on anything. After filing a lawsuit, direct all communication between you and the insurance company to your attorney.
- Every state in the United States has its own different “bad faith insurance” laws, make sure you go through it and also ensure that your attorney is an expert in these laws.
- Bad faith insurance laws usually involve contingency fee payments, meaning you will only pay an attorney when you win or settle the case.
Suing your health insurance company
If you file for a claim in court it is probably under a “bad faith insurance” claim. A claim like this against your health insurance company may have resulted from insurance company fails to respond in a timely manner to your claim, failure to investigate the claim or refusing to settle or declining a claim.
Bad faith insurance claim requires your insurer to prove beyond a reasonable doubt that it acted appropriately. This means that the insurance company must prove its innocence.
An attorney can help you with the review process and advise you whether you should bring a lawsuit against the insurance company. An experienced attorney will present strong evidence for your case and represent you in court.