Aizenman Law Group Fights for Policyholders Like You
The insurance claim attorneys at Aizenman Law Group proudly offer our legal representation to health insurance claimants who have had their claims wrongfully denied by their insurance providers. Reach out to a Tulsa health insurance lawyer. Your health is at risk when your health insurance claim is denied, so we get right to work on your case. Allow our wrongful claim denial lawyers to review your claim, send an appeal, and take legal action on your behalf if the insurance company plays hardball.
Why Was Your Health Insurance Claim Denied?
Very rarely does an insurance company outright deny a health insurance claim without giving a reason. Doing so would put them at an obvious risk of being accused of wrongful denial insurance tactics, or willful neglect of their obligations under Oklahoma Law. Instead, they usually provide a direct reason for the denial, even if it’s not applicable. A wrongful claim insurance attorney will spot faulty reasoning in insurance company decisions.
Common reasons why health insurance claims are denied include
- Lapse in policy coverage: The specifics of your insurance policy can lead to a lapse in coverage, resulting in a denial. For example, specific medical procedures might be specifically excluded from your insurance policy. Or, you might have to choose medical providers within a particular network. Choosing someone outside the network would result in your insurance no longer covering your medical treatments.
- No medical necessity: Health insurance companies often engage in wrongful claim denial by saying that a medical treatment was not medically necessary and, therefore, does not qualify for coverage. Denial can also occur if the procedure is considered experimental by the broader medical community. Essentially, your healthcare insurance will only cover treatments that medical providers deem necessary and will look for ways to deny coverage whenever possible.
- No referral or approval: Some medical procedures should only be completed after a referral is received from another medical professional. This is particularly important for specialized treatments like spinal surgeries that may result from accidents requiring a spinal injury lawyer’s involvement, or comprehensive rehabilitation services following incidents where a slip and fall lawyer has helped establish liability.
- Expired timelines: There are also common time limitations for both coverages and treatment allowances. Your claim could be denied if the insurance company does not receive the paperwork on time. Waiting too long to receive a covered treatment could also jeopardize your health insurance claim.
How Our Attorneys Help with Your Denied Claim
Our Tulsa health insurance claim attorneys’ step in and take over after a claim is denied. You obviously would not file an erroneous or unjustified health insurance claim, so why does your insurance company engage in wrongful claim denial? The answer is simple. To save themselves money at your expense. We won’t let it happen.
Our insurance claim lawyers will thoroughly review your health insurance policy and the denial to determine the root cause of the situation.
After reviewing your policy and their reasons for denying your claim, we can
- Appeal the decision: This is the first step when challenging an insurance company’s wrongful claim denial. Drawing on our extensive experiences as former insurance defense attorneys, we can craft an appeal letter that clearly explains why their decision constitutes a wrongful denial. In many cases, we can use an appeal letter and continued negotiation to reach a fair settlement without the need for litigation.
- Negotiate with your carrier: There are times, though, when an insurance company stands stubbornly behind its wrongful denial of a health insurance claim. When this occurs, we can threaten litigation based on their wrongful denial insurance tactics. At this point, the insurance company may look to avoid litigation expenses and the risk of the jury awarding you maximum compensation.
- Litigate: The next and final step is actually taking your case to litigation, all the way through trial, if need be. Our insurance claim attorneys are ready to fight on your behalf before the court and jury to show how the insurance company’s wrongful denial harmed you. Your case could even create case law that benefits others in similar future situations.
