Did You Have an 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 well-being. 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, consulting with an Oklahoma insurance claim lawyer may be a valuable step to understand and explore your options.
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 lawyer Doug Terry has a strong record of success, with $200 million and $25 million verdicts won for clients in cases in which an insurer denied a health insurance claim. Don’t wait to get help. Doug is ready to represent you and your best interests. Give us a call at 405-463-6362 to schedule your free consultation today.
We Fight for Patients’ Rights Against the Big Insurance Companies
In his closing arguments at the trial, Cunningham’s lawyer, Doug Terry, condemned Aetna’s medical directors: “These doctors were not properly qualified to know the first thing about the medical issues involved here. None of them had any experience with radiation oncology or proton therapy. They were cranking out denials as fast as they could.”
Why Choose Our Oklahoma Health Insurance Lawyer
We Know the Applicable Laws and the Health Insurance Industry
If your health insurance claim has been denied or underpaid, the financial burden of these expenses falls unfairly, and possibly illegally, on you. Denied medical claims can result in life-changing debt impacting you and your family.
Many believe that health insurance companies operate in the best interests of their clients and that their decisions cannot be questioned. This is categorically untrue. In fact, these organizations’ loyalties lie with their shareholders, not their clients; their ultimate goal is to maximize their profits. Since paid claims negatively impact revenue, they are motivated to underpay and deny them.
Unfortunately, many health insurance company decisions are not made in accordance with the law. Engaging the best firm to represent you and manage your health insurance lawsuit is the first, and perhaps most important, decision you need to make regarding your future.
It is important to work with an attorney who not only understands the complex laws surrounding health insurance, but one who also appreciates the physical and emotional trauma you have experienced. You want to be confident that your case will be handled appropriately and that you will be treated with the care and respect you deserve.
If you are struggling with a denied health insurance claim, Doug Terry Law is well-positioned to help you. Consider our:
- Industry-Focused Knowledge and Experience: Attorney Doug Terry worked for a firm which defended insurance companies and then founded his own firm to represent those who needed him most. He knows both the tactics these companies take and how to beat them. Our team has handled countless cases throughout Oklahoma, positively impacting individuals as we helped them maximize their health insurance claim settlements.
- Focused Approach to Service: Claims denials leave individuals frustrated and frightened. The idea of moving forward with legal action is overwhelming. At Doug Terry Law, we are known for both the empathic way we interact with our clients and the tenacity with which we approach negotiations and litigation.
- Reputation for Success: Our team is known for winning cases like yours and helping the citizens of Oklahoma get the reimbursement to which they are entitled. We take the time necessary to learn the ins and outs of your case, interact kindly, and positively impact the legal process.
If your health insurance claim has been denied, it is entirely possible that the action was not made in good faith. We can review your claim history, help you to address legal issues and get the reimbursement to which you are entitled. Contact our health insurance lawyer today at 405-463-6362.
How Our Denied Health Insurance Claim Lawyer Can Help
You’re Not Alone in the Battle
If you suspect your insurance company is acting in bad faith, seek legal guidance regarding the types of damages available to you. It is likely that you have no idea how to move forward. That’s okay — we do! Doug Terry has dedicated the majority of his practice to helping people just like you, those 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.
Our team is committed to helping you. We will:
- Provide a No-Cost Consultation: During this informational meeting we will learn more about the specific circumstances surrounding your case. We know that no two situations are identical. Based on our evaluation, our health insurance claim denial attorney can provide you with important guidance and next steps.
- Conduct a Full Investigation: We will conduct a thorough review of your health insurance policy, the submitted claim, and all physician information. Additionally, we will examine all communications — not only what was said, but also the timing of the messages.
- Manage All Administrative Processes: Completing paperwork correctly and filing it in a timely fashion is critical. We assume responsibility for this, ensuring everything is completed in accordance with the law.
- Calculate Your Losses: Sometimes delayed claims can result in additional financial losses. We help identify these damages and ensure they are included in your lawsuit.
- Communicate and Negotiate on Your Behalf: We will assume responsibility for all emails and telephone calls regarding your case, ensuring all communication is clear and negotiations are direct and in your best interests. If an insurance representative or attorney contacts you, refer them to us and end the conversation. You do not want to accidentally say something to jeopardize your case.
- Represent You in Court: While our goal is to settle your case in the negotiation stage, sometimes we cannot reach an acceptable agreement. In situations like this we never hesitate to go to court. We are aggressive litigators dedicated to positively impacting our clients’ settlements.
When you work with us, we take responsibility for the entire legal process from beginning to end. You can focus on your recovery and your future.
If your health insurance claim has been unjustly denied or delayed, Doug Terry is here for you. We can help with your health insurance appeal. Contact our office today at 405-463-6362 to schedule your free case evaluation.
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 are a matter of life or death. Waiting for an approval 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 if your insurance company either unjustly denied your claim or unreasonably delayed in making a decision.
“Doug Terry is one of the best lawyers in this state. He will always look at all options and I will speak from personal experience that he is not all about the money he cares for the individual and has their best interest in mind always. Any bad reviews for him must come from people that did not have a good reason in Mind. He will always do what’s right.” – Anonymous (Birdeye Review)
$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 often have unqualified medical personnel reviewing policyholder treatment. For example, if a policyholder requests coverage for radiation treatment for cancer, and the insurance company assigns a family practitioner to determine coverage, bad faith may be asserted. You see, policyholders have the right to expect their claims to be carefully and thoughtfully reviewed by a properly qualified doctor or nurse – those with specific background and knowledge necessary to understand the medical issues at hand and make fair decisions regarding coverage. Unfortunately, general physicians, as opposed to specialists, are often consulted, and policyholders are not provided the specialized consideration to which they are entitled.
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 those deciding claims. They must understand what the duty of good faith requires the company to do. How can someone working at a health insurance company comply with the duty of good faith under the law if they don’t know what this requires? They can’t. Incredibly, health insurance claims are frequently 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
Understaffed and overworked. As they continue to strive to decrease expenses, health insurance companies often pressure their employees to handle many claims quickly. They don’t have the time to conduct a thorough review. Unfortunately for policyholders, this means that the doctors and nurses reviewing health insurance claims and deciding how to pay them 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 that their insurance company takes the time necessary to fully understand all aspects of a claim prior to making a decision. Sadly, the rushed decisions made by health insurance companies are often “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; they should treat policyholders’ interests with equal regard as the insurance company’s interests. If those professionals are financially incentivized 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. Sadly, this unethical practice frequently occurs, and policyholders bear the burden.
Doug Terry Law: Ready to Address Your Denied Health Care Claims
Contact Our Denied Health Insurance Claim Lawyer Today
At Doug Terry Law, we understand how to aggressively address denied claims while empathetically managing the legal process. We know you are frustrated and concerned about your financial future.
Payment on your medical insurance claims are not a luxury: they are benefits due to you for losses you have experienced based on the policy for which you paid. When claims are denied, you absorb the financial burden. We will address these issues on your behalf and work tirelessly for a positive outcome.
Years ago, Doug Terry founded his firm because he saw the unfair ways in which insurance companies treated individuals, and he believes that ordinary people need and deserve the same high quality legal services as large corporations.
Our clients have the entirety of our firm’s resources behind them as we work to right the wrongs of their health insurance companies.
When declined claims are an issue, act quickly. Contact our team at 405-463-6362 to schedule a free consultation. Let us review your case and explain how we believe we can best support you.