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Legal Representation for Denied Health Benefits

By Edited Jan 11, 2016 0 0

Many people have to seek legal representation for denied health benefits.  This has actually been going on for years now.  Many insurance companies are now quick to deny claims and quick to deny payment for needed medical services.  Unfortunately, in many cases, the only way you can get what you are entitled is to take action in court, or at least hire an attorney to communicate with the insurance companies.  Let’s look at why claims are denied, what you can do about it, and what avenues you may wish to take when you are forced to look at legal representation for denied health care benefits.  If you are refused, you may want to consider free law advice by phone.

Common Refusal Reasons

Before you actually go out and hire an attorney, it may be beneficial to find out what caused the refusal to pay.  Many insurance companies have strict guidelines before they will pay out a claim.  For this reason, it could be beneficial to do some work on your own before you secure legal representation for denied health benefits.  These are just a few of the things that could result in a refusal to pay from the insurance company.  Some of the items listed are easy to fix.  If you have a good case, you might be able to get a legal line of credit.

Not Included in Policy:  Simply put, some procedure, medicines, and other forms of medical treatment will not be covered by your agency.  Before you secure an attorney for unpaid claims, you may want to carefully go over the exclusions listed in your policy.  The types of exclusions are all over the board, so it really makes it difficult to narrow them down.  For example, some policies will not cover any mental health related issues.  Keep this in mind and do some research before you secure legal representation for denied health benefits.

Medical Professional Errors:  Sometimes your medical provider may fail to fill out a form properly to get a claim paid out.  This is not that uncommon and is generally not that terribly hard to fix.  If the company states this was the problem, ask them to mail or fax the form, along with a copy to you, so it can be filled out correctly.  If you have no luck, you may need to get legal representation for denied health benefits.  It is definitely something worth looking into.  Since this type of human error can be fixed, you must do everything in your power to attempt to fix it on your own, to avoid the expense of an attorney.

Excessive Cost:  Some providers will only pay “normal and customary” costs for any services provided.  This is a common reason for denied health benefits.  If the company is balking at a substantial portion of the cost, you may need to prove that their guidelines are out of date.  This would generally require legal representation.  It could involve a lengthy court proceeding to prove your case.  It’s something to keep in mind before you make any final decisions.

Excessive Hospital Stays:  Perhaps you stayed in the hospital too long, or went to the ER when you didn’t necessarily have to, according to the company.  In the case of staying in the hospital too long, the doctor may be able to communicate with the company that it was necessary, and get the claim paid.  This may be better than having to go out and seek legal representation for denied health benefits.

Help You Can Get

If none of the above applies, you may be still thinking you need to hire an attorney.  In many cases, you will.  While the medical insurance lawyer will be able to help you get the benefits you need, there is only so much they can do to help you out in your situation.  In general, there are two basic choices the attorney will explore.  Here are the basic options that they will go over with you.

Settlements:  More often than not, the attorney will try to negotiate a settlement with the company rather than going to court with a lawsuit.  Ultimately, this is much timelier for everyone involved.  The medical provider will not have to wait as long for their money, the lawyer will have a lower fee, and you will get it all behind you quicker.  This type of settlement is often done through simple communication between your legal representation for denied health benefits and the company’s attorneys.  You will generally not be involved in the discussions, but your lawyer should communicate progress with you routinely.

Lawsuit:  You may have to take the insurance company and in some cases, the medical provider, to court to get your claims paid off.  Your attorney will go over the details with you in more detail.  This will vary greatly by case.  Those seeking legal representation for denied health benefits must keep in mind that it could easily go this far.

Problems You May Face

Anytime you are seeking legal representation for denied health benefits, you will have some serious obstacles to climb.  These will vary depending on the details of your case, but in general, they could include some of the following.

Credit Report Damage:  The medical provider may hold you accountable for the bills that are unpaid, even if you are in litigation.  They could report failure to pay to the credit bureaus, which will impact your score.  This impact could take years and years to overcome, so it’s something you will need to take into serious consideration before you get legal representation for denied health benefits.  It’s just one  of the many considerations you will need to take into account when you make a decision.

Loss of Time:  If you have to go to court, it will take up a lot of your time.  It’s just a simple fact.  This could lead to problems at work, including loss of income, as well an inability to make plans during the trial timeframe.  The inconvenience can be pretty severe, so keep it in mind before you seek legal representation for denied or unpaid health benefits.

Lawyer Fees:  Lawyers don’t work for free, so you could win your case, but still have to pay a hefty sum to get the claim paid off. 

 

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