Did You Have a Health Insurance Claim Denied?
When it comes to health insurance, the insurer can’t put its profits ahead of your health.
You rely on your health insurance company to cover appointments, tests, and procedures that are vital to your health and wellbeing. Unfortunately, unjustly denied health insurance claims can leave patients with the responsibility to foot large medical bills. Sometimes a claim denial can force the policyholder to go without needed medical treatment. If you’ve recently had a claim denied, you may be wondering what your options are.
If you believe your claim has been incorrectly denied or if you have other reason to believe that you’re being treated unfairly by your insurance company, it’s time to seek legal advice from an experienced insurance lawyer.
Our health insurance claim denial attorney Doug Terry is here to help represent you and your best interests; give us a call at (405) 463-6362 to schedule your free consultation today.
What Are a Health Insurance Company’s Obligations?
When you need approval for a medical procedure or other treatment from your insurance company, your insurer must proactively investigate and fairly evaluate your claim.
Some medical procedures can even be a matter of life or death, so waiting around for an approved request isn’t always an option. As a result, health insurance companies have an obligation to act on these types of medical requests within a reasonable time frame. A “bad faith” claim could be your best option then, when an insurance company either unjustly denies your claim or delays making a decision on your claim for an unreasonable amount of time. Getting the advice of an experienced insurance lawyer is your best strategy.
$25.6 MILLION VERDICT IN AETNA CASE
Orrana Cunningham was diagnosed with stage IV nasopharyngeal cancer at age 53. Medical providers determined her tumor would be best treated with proton therapy rather than radiation therapy because of its precision and reduced chances of serious side effects. In an act of bad faith, Aetna denied payment for this treatment, claiming it was “experimental or investigational.” We proved to the jury how and why Aetna was wrong.READ MORE ABOUT THE AETNA CASE
Tactics Companies Use in a Health Insurance Claim Denial
Through our experience, we’ve become familiar with how insurance companies work to deny or underpay claims.
- Unqualified nurses and doctors deciding claims
- Untrained people deciding claims
- Overworked nurses and doctors deciding claims
- Biased nurses and doctors deciding claims
A Closer Look...
Insurance company tactics to unfairly deny claims can involve medical providers.
Unqualified Nurses and Doctors
Health insurance companies all too often have unqualified medical personnel reviewing claims for treatment from their policyholders. An example would be when a policyholder requests coverage for radiation treatment for cancer, and the insurance company assigns a family practitioner to decide if the treatment is covered. A policyholder has a right to expect their claim to be carefully and thoughtfully reviewed by a doctor or nurse with the proper qualifications to understand the medical issues and make a fair decision about coverage for the treatment. Unfortunately, this does not often happen.
Doug Terry took on Aetna in court for denying a cancer treatment claim. CNN interviewed Doug about another case involving an M.D. working for Aetna who made a decision on a claim without review of the medical files.
Lack of Proper Training Can Lead to Unjust Denial of Health Insurance Claims
In order for an insurance company to meet its duty of good faith owed to its policyholders, it must properly train the people it assigns to decide claims on what the duty of good faith requires the company to do. In other words, how can someone working at a health insurance company comply with the duty of good faith under the law if they don’t even know what they are required to do to comply with the law? The answer is: they can’t. This just makes common sense. But, incredibly, all too often health insurance claims are being decided by insurance company employees who have not been given the proper training on how to handle a claim in good faith.
Overworked Doctors and Nurses Deciding Health Insurance Claims
Health insurance companies often put a great deal of pressure on their employees to handle far too many claims in far too short of a time. The negative effect of this for policyholders is that doctors and nurses deciding health insurance claims often fail to spend enough time reading the medical records, the insurance policy language and the appeals sent by treating doctors before deciding claims. A policyholder is entitled to expect an insurance company will at least spend the time necessary to develop a full understanding of a claim before making a decision. Unfortunately, all too often, the rushed decisions made by health insurance companies are “rubber stamp” denials.
Biased Nurses and Doctors Deciding Claims
The nurses and doctors deciding a policyholder’s claim should not be placed in a conflict of interest situation, but should instead treat the policyholder’s interests with equal regard as the insurance company’s interests. If those nurses and doctors are compensated in a way that gives them a financial incentive to deny policyholders’ claims, a real danger of bad faith claim denials exists. An insurance company that pays its claim decision-makers in any way based on the number of claims they deny or based on the profit of the insurance company risks bad faith claim denials.
How Our Denied Health Insurance Claim Lawyer Can Help
You’re not alone in the battle.
If you suspect your insurance company is utilizing these tactics on your claim, it’s important that you seek legal guidance about the types of damages available to you right away. Our very own Doug Terry has dedicated the majority of his practice to helping people just like you who have been wronged by their insurance companies.
With a focus on bad faith insurance cases, our firm has a longstanding reputation for working tirelessly for people who have been taken advantage of and were wronged by their insurance companies
We’ll begin with a free, no-obligation case evaluation to find out more about the circumstances surrounding your case. From there, a health insurance claim denial attorney can provide you with important guidance and next steps. Should you choose to retain our services, we can get to work right away on handling and building your case, putting our years of experience in handling bad faith insurance cases to work for you.
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