Health insurance claims can be extremely complicated. Whether you need to visit a doctor for a certain procedure or get a prescription filled, it can be difficult to understand whether your health insurer will cover your claim. One study from Policy Genius revealed that more than 25% of people have avoided health care or treatment because they didn’t know what their health insurance covered.
The worst-case scenario is that you assume your health insurer will cover an office visit or procedure, yet you see the dreaded word “denied” in correspondence from them. A health insurance claim denial doesn’t need to be the end of the story, however. Sometimes you need to fight for your rights—especially if your insurer made a mistake or violated your policy when denying your claim.
Ultimately, a lawyer can be a trusted advocate who can advocate for your rights. Regardless of the size of your claim, hiring a lawyer can substantially increase your chances of reversing the insurer’s initial decision and obtaining coverage for your procedure, office visit, or prescription.
When disputing denials of health insurance claims, attorneys can provide value in several different ways.
Primarily, attorneys leverage their background and expertise to appeal your health insurer’s decision. He or she can quickly and efficiently understand your claim and prepare a strong case for appealing your insurer’s decision. Whether you’re disputing a denial of coverage for a particular surgery or long-term care, your attorney can use the facts to present compelling arguments for a reversal of the denial to your insurer.
Along with this, your attorney has procedural expertise. As you can guess, a deep understanding of the procedural aspects of claim denials is priceless. It helps avoid wasted time and frustrating correspondence with your health insurer. Ultimately, your attorney understands the nuances of the appeals process. They have likely litigated against your health insurer for other clients, too. In sum, delegating your appeal to an attorney can make the appeals process proceed much more smoothly.
Clearly, attorneys can provide massive value in both the substantive and procedural aspects of your appeal. But that isn’t the only value that attorneys can provide. Specifically, they can free up your time and provide some peace of mind. If you are recovering from major surgery, for example, you likely won’t want to read the fine print and participate in hour-long phone calls with your health insurer. Even if you did want to proceed alone, the claim appeal process is nuanced and complicated. It’s easy to make a mistake and scuttle your chances of reversing the insurer’s decision. An attorney will help you avoid these unforced errors and handle those inconvenient calls with your health insurer.
Ultimately, hiring an attorney to dispute your health insurance claim denial is an investment – not only in a successful appeal, but in your future mental health. While there is no guarantee of a reversal, an attorney can substantially increase your chances of success. At the very least, your attorney can take this task off your plate, allowing you to focus on getting better.
At Louis Law Group, we have extensive experience in working with clients to dispute health insurance claim denials. Our attorneys are happy to work with you and advocate for your rights when corresponding with your health insurer. To learn more about how we can help you navigate your health insurance claim denial, don’t hesitate to contact us.