Tips for Appealing a Denied Medical Claim

aJust Solutions is a unique patient’s advocacy company that specializes in dealing with denied medical claims and medical debt negotiations. As we’ve discussed in the past, healthcare has a history of wrongfully denied medical claims in California and throughout the US. If you have had your health insurance claim denied by a healthcare insurance company, you might have the right to appeal a denied claim.

Carefully Review the Denial

When insurance companies deny a claim, they are required by law to give specific reasons for doing so. They are not permitted to vaguely reject a claim without fully informing the beneficiary. Continue reading for tips on how to appeal your Healthcare insurance denial from our experienced team of professional medical advocates of their reasons. If your Healthcare claim is denied, the notice of denial should include all relevant details including the facts in the medical record and the specific provisions in the policy that apply to the denial. They will make clear whether the medical denial is based on an excluded procedure in the policy, missing medical evidence, incomplete medical claim forms, policy lapse, or any other reasons.

The denial notice will be your roadmap for responding to the denial. If the denial does not explicitly state the reasons for denial, then the company is violating the law. You may have a medical claim not only for wrongful insurance denial but also for insurance bad faith behavior. Your insurance denial lawyer can request additional clarification from Healthcare, as well as threaten legal action should they persist in denying your claim without proper justification.

Carefully Review the Identified Policy Provisions

Review and Compare The reasons stated in the denial with the conditions lin the policy documents. If they cite the reason as explicitly not covered, you need to carefully read your policy document to find out where exactly it is mentioned. If you are unable to find that in your policy, there you go you have found the reason to reverse their decision. If the reason mentioned in denial is due to pre-existing conditions, you need to get a written explanation from your doctor telling them that the condition is not pre-existing.

Gather Important Documents and the Evidence

Many Health insurance claims are denied simply because there’s a lack of supporting evidence with the claim. You’ll almost always want to collect the basic documents relating to the death, including the autopsy report, police report, toxicology report, and others. You might need to collect medical archives regarding the decedent. Often, if you can provide the missing evidence, the insurer will reconsider their denial. Your attorney can help you track down the missing documents and make sure your appeal is fully supported.

Call an Insurance Claim Denial Lawyer, and Do It Soon

If your Health insurance claim is denied, you only have so much time to respond to the denial and/or seek an appeal. Insurance companies often give beneficiaries 60 days to appeal their decision. If you wait too long, you’ll miss your right to appeal and make it much more difficult, if not impossible, to get the benefits you deserve. Moreover, Healthcare may have denied your claim for a reason contrary to California law. Unless you are an insurance law expert, you are unlikely to know all of Standard’s obligations and the limitations on their grounds for denial.

Talk to an experienced insurance denial attorney as soon as you can after receiving your claim denial from Healthcare. You and your attorney can start building your response to the denial, gathering the necessary documents and identifying any weaknesses in your reasoning. The sooner you contact an attorney, the more time they’ll have to help you put together the strongest appeal, and the faster you’ll get the benefits you deserve.

Call a Health Insurance Denial Lawyer Today for Help with a Rejected California Health Insurance Claim

If your Health insurance claim has been wrongfully denied by Healthcare, or if you are dealing with other bad faith insurance issues in California, you should, fight for the coverage you deserve with the help of the experienced and professional Patient’s advocates. You can call them for a free consultation session at: 855-657-3311.

Isabella Bautista is a dedicated healthcare professional. Ms. Isabella Bautista' command over various medical topics gives her an edge as a content writer and sets her apart from the rest.