A Team of Health Insurance Lawyers Standing up for Your Rights
Most individuals purchase health insurance for greater peace of mind, knowing that necessary procedures are covered. However, if your insurance denies your claim, the process of getting the coverage you deserve can quickly become complicated and frustrating. Appealing the denial of a valid health insurance claim requires an advanced understanding of the appeals process, as well as the legal precedents surrounding insurance bad faith.
A health insurance lawyer from The Tawwater Law Firm in Oklahoma can help you file the paperwork for an appeal or, in more serious situations, build a case for a lawsuit. The attorneys at our firm have spent over 36 years resolving insurance disputes for our clients. For more information about how we can help you, contact our office online or call (405) 607-1400 to speak to a member of our team today.
Why Are Claims Denied?
Unfortunately, many health insurance providers are more focused on protecting their bottom line than providing the payments you deserve. To avoid paying the appropriate settlements, companies often use less than legitimate reasons for denying, delaying, or underpaying claims.
Commonly Used Excuses
There are many reasons a valid claim may be denied. Your provider may say that coverage was not included in your policy or that your health care provider charged more than the customary amount for a certain service. In other cases, insurance carriers will say a treatment is not medically necessary based on the assessment of an in-house doctor who has never met you, let alone examined you. Other common excuses for denying a claim include:
- The treatment is experimental.
- You are out-of-network.
- The procedure is purely cosmetic with no health benefits.
- You misrepresented something in your original claim.
- They never received proper paperwork.
The provider may also delay your payment by saying they are waiting for a third-party evaluation to confirm the price or necessity of your procedure. In these situations, you need an advocate who can stand up for you in the face of bad faith techniques designed to keep you from receiving the benefits for which you paid.
The Appeal Process and How We Can Help
It is important to keep in mind that much of the appeal process is determined by your coverage agreement with your insurance company. However, there are several stages involved in a typical appeal.
If you believe your insurance company has denied you coverage unfairly, you will likely have to file for an internal review first. To file an internal appeal, you must complete all necessary forms and submit a written request documenting your case. Be sure to include any information you wish the insurer to consider. You must file an internal appeal within six months of your claim being denied.
We provide aggressive legal representation for all of our clients involved in bad faith insurance disputes.
An internal appeal can take anywhere from 30 to 60 days, depending on whether you have received service already. In urgent cases, this review process can be expedited. At the end of the process, the insurance provider must deliver a written decision regarding your claim.
Independent External Review
If you are still denied coverage after the internal appeals process, you can have your dispute reviewed by experts who are independent from your health plan. The Oklahoma Insurance Commissioner has a process in place for appealing the result of your internal review. You will need to file your request within four months of the date of the final internal decision.
Filing a Lawsuit
If, at the end of the internal and external review, you still believe you were treated unfairly, you may be able to file a lawsuit against your insurance company. The insurance dispute attorneys at The Tawwater Law Firm can assist you with this process. We provide aggressive legal representation for all of our clients involved in bad faith insurance disputes.
Hire an Advocate Who Can Fight for You
When you are dealing with a large insurance company, the process can be slow and frustrating. In the end, you may not receive the benefits you deserve. Our team at The Tawwater Law Firm can support you throughout the appeals process. If the process fails, we can provide aggressive representation and pursue the compensation your provider owes you. To find out more about our insurance dispute services, contact our practice online or call us at (405) 607-1400 to schedule a consultation with our team.