Emergency Room Surprise! How to Fight a Denied Claim After an ER Visit

June 11, 2024

Emergency Room Insurance Claims Are Frequently Denied ER Visits Can Be Expensive Nobody wants to go to a hospital emergency room.  Unfortunately, life is unpredictable, and when serious medical needs arise an ER is often the best place for treatment As a result of the services they provide, including immediacy of care, emergency rooms are often the most expensive places to be treated for illness or injury. The high cost of emergency room visits is particularly problematic for insurance companies burdened with the costs for their policyholders.  Because of the urgency of necessary treatment, most emergency room patients are only aware of the costs of their care once they receive the hospital bills.  There is often no time for pre-approvals and treatment is provided immediately, as needed. Becau... Read more

How Do Health Insurers Decide If Treatment is Experimental or Investigative?

May 6, 2024

Medical Treatment Is Ever-Changing If you watch the daily news, you know that advances in medical treatments for a broad range of illnesses occur regularly. Researchers across the country and around the world work diligently to identify cures for diseases and treatments to alleviate the devastating effects many who are affected suffer. Each discovery is met with joy as it provides hope for those who are ill and their families. Perhaps nothing is as disappointing as having a health insurance company deny your claim stating the treatment is either experimental or investigative. Those who receive these notifications may be paralyzed with fear. Their physicians finally identified a treatment that could help, and now the insurance company will not approve payment. Because the price of medical treatment is o... Read more

How to File for an External Review of Your Denied Health Insurance Claim in Oklahoma

April 26, 2024

External Insurance Reviews Provide Hope Denied health care claims have, unfortunately, become commonplace, both in Oklahoma and across the country. In a never-ending effort to remain profitable, health insurance companies regularly delay, underpay, and outright deny claims, leaving individual policyholders unable to get the treatment they need or saddled with astronomical medical bills. If your health insurance claim has been denied it is important to recognize that the decision may not be final and that you do have recourse. The processes for internal appeals and external reviews can be complex. Insurance companies engage teams of individuals, including legal professionals, to minimize their expenses by defending their actions. If you are struggling with inappropriately paid claims, engaging lega... Read more

What Damages Can I Recover From an Insurance Bad Faith Case?

April 15, 2024

Bad faith actions by insurance companies are an unfortunate reality of today’s world. Every day these organizations make decisions that are not in the best interests of their policyholders; they are also simply unfounded and based on information designed to minimize reimbursement, therefore maximizing corporate profits. In short, their loyalties lie with their shareholders, not their policyholders. In Oklahoma, insurance companies are required to act in accordance with the terms outlined in the policies they issue and in good faith. This means that policyholders have legal recourse when claims are unfairly denied; insurance companies can be held liable for their bad faith actions. Those who were wronged may be entitled to settlements designed to compensate them for their losses. Understanding the D... Read more

Fighting Your Health Insurance Cancellation

April 12, 2024

Every day individuals living in Oklahoma receive notice that their health insurance policy has been canceled. Messages like this are frightening; we all rely on our medical insurance to protect our financial and personal well-being if and when we get sick. Not having coverage leaves our health at risk and our future vulnerable to the exorbitant costs of medical care. If you have been notified of a health insurance policy cancellation, you must take action. The reason for the cancellation can guide your actions going forward. Knowing what to do and how to do can be confusing. In many cases, working closely with a health insurance cancellation attorney can prove valuable. These professionals understand the laws governing insurance and know how to address issues as they arise. You want to approach this ... Read more

Bad Faith Tactics with Car Insurance Claims

April 2, 2024

Has your car insurance company unreasonably and unfairly denied your damage claim? If so, you are not alone. Unfortunately, these refusals to pay happen all of the time. You see, insurance company claim departments too often create a culture among their adjusters that encourages them to do whatever it takes to pay less on the claims of the company’s policyholders, even when that means engaging in unreasonable and unfair claim handling practices. These bad faith tactics are unethical and may, in fact, be illegal. Quite often policyholders are unaware of the fact that the law requires insurance companies to treat them in compliance with the duty of good faith and fair dealing. Therefore, when their insurance company delays and underpays their claims, they simply accept the offers as final. They do not belie... Read more

Write a Health Insurance Claim Denial Appeal That Works

March 26, 2024

Health insurance claim denials are a problem that many in Oklahoma City and across the state deal with daily. Health care is costly.  When claims are denied, one of two things results:  either the individual whose claim was denied does not receive the medical care they need, or the financial burden of paying for necessary treatment falls upon the individual themselves. When a claim is unfairly denied, neither option is acceptable. Unfortunately, many simply don’t know how to respond appropriately. In cases like this, addressing the denial with an appeal letter is the first course of action. Completing this task appropriately is important, as errors in the process may result in the insurance company’s refusing to review your case or denying your claim once again. Engaging the assistance of a health... Read more

Aetna to Pay $3.4 Million in Proton Therapy Case

March 14, 2024

Aetna Denied Coverage of Proton Therapy Cancer Treatment for 142 Patients According to the Centers for Disease Control (CDC), more than 1.6 million individuals are diagnosed with cancer each year, with over 600,000 losing their battle. Understanding this, it’s no surprise that considerable resources are focused on research and new treatments constantly arise. Proton beam therapy, a relatively new radiation treatment, has proven successful in treating a range of cancers; it is safer and more effective than X-ray or photon-based treatments. Thus, oncologists across the country are relying on it to help their patients. Unfortunately, insurance companies commonly reject health insurance claims for this treatment, negatively impacting the health of their policyholders. In one instance, Aetna, in particu... Read more

Did Your Auto Insurance Company Act in Bad Faith?

March 8, 2024

Each year, the National Association of Insurance Commissioners tracks the top reasons why insurance customers complain about their auto insurance coverage… and each year, “denial of claims” makes the top three. It’s not surprising that every day in Oklahoma auto insurance companies deny and delay claims. In some cases, their decisions are warranted, but in many others they are acting in bad faith. When you purchase your car insurance policy in good faith, and pay your premiums on time, you expect that your claims will be paid expeditiously and in accordance with your policy. Unfortunately, this doesn’t always happen. It’s not surprising that if you receive a denial letter you are frustrated. Understanding the reasoning behind the denial is key to knowing what to do. Individuals living in ... Read more

Which Health Insurers Deny the Most Claims?

March 5, 2024

If you paid your health insurance premiums on time, believed the treatment you received was covered, and submitted your claim correctly, you likely assumed it would be paid appropriately and in a timely fashion. A denial of the claim would likely leave you frustrated at the process and worried about your financial responsibility. These concerns are real . . . but there is good news. You do not have to accept your insurance company’s denial as final. There are steps you can, and should, take. Knowing what to do and who you can rely upon for help is the first step toward appealing your claim. Health Insurance Claim Denials Are Common The Kaiser Family Foundation Tracked Insurers’ Denial Rates Insurance claim denials are aggravating; if you have experienced this you know exactly what we mean. Unfortunat... Read more