Needless to say, our society is currently built upon a foundation where health insurance does not benefit everyone in all situations. In fact, health insurance companies are for profit at the end of the day, so they may prioritize their pocketbook and not fair coverage that a person needs. It is devastating to realize that in our culture health insurance is not just a given and fair for everyone. As someone who pays into health insurance, it can make the matter even more distressing if a health insurance claim denial also results in an exacerbation of a personal injury. Simply the stress of realizing that your insurance claim did not get covered can be enough to result in mental anguish and overwhelm about what happens next. Health insurance claim denials are incredibly frustrating, but there are steps that you can take to appeal or avoid them from happening. 

Reasons For Denials

It may seem like there are limitless reasons why an insurer may deny payment for a certain healthcare service. Some reasons are simple and understandable, and others may be confusing and more difficult to believe. The most common reasons for denials include paperwork errors or mix-ups, questions about medical necessity, cost control, provider network issues, missing details, not following health plan rules, or the service just wasn’t covered by the plan. Unfortunately, this leaves a lot of room for potential bias or making a mistake when it comes to denying a fair claim. People are at the mercy of whoever decides whether coverage should be provided, or not. Because of all the ways that a person may have their claim wrongfully denied, it is not uncommon for people to speak with an injury lawyer for assistance. Having a lawyer’s representation to handle an insurance claim denial can make all the difference in the outcome of an appeal or litigation. An experience health insurance lawyer can walk you through the steps of appealing a denial and ensure your paperwork is strong for approval of your claim. 

Byproducts of a Denial

Realizing that an expensive medical service will not be covered can affect a person’s mental health. A person may then have to wonder where they will get the money to afford this new bill. Will you have to work more hours? Will you have to find another job? What will be the consequences if you are unable to pay? These are all normal concerns that anyone facing a health service denial would probably feel. A claim denial does more than inconvenience someone, as they can become vulnerable to further injury simply because of the stress. Anyone who has ever been so distracted from a stressor can attest to how everything else may fall to the wayside. To make matters worse, someone may shortly thereafter be involved in an injury event, like a car crash or workplace accident (from overworking to afford the bill). As our friends at Cohen & Cohen can attest, dealing with more injury on top of an already difficult situation can become a byproduct of a health insurance claim denial.  

If you have a denied health insurance claim and need an experienced California health insurance attorney to review your claim denial, please contact us for a free consultation.