Aizenman Law Group Fights for Policyholders Like You
Aizenman Law Group proudly offers our legal representation to health insurance claimants who have had their claims wrongfully denied by their insurance providers. Your health is on the line when you have your health insurance claim denied, so we get right to work on your case. Allow our legal professionals to review your claim, send an appeal, and take other steps on your behalf to secure the coverage you deserve.
Why Was Your Health Insurance Claim Denied?
Very rarely does an insurance company outright deny a health insurance claim without giving a reason why. Doing so would put them at an obvious risk of being accused of insurance bad faith, or the willful neglect of their obligated duties as an insurance provider. Instead, they will usually provide a direct reason for the denial, even though it might not apply.
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, certain medical procedures might be specifically excluded from your insurance policy. Or, you might have to choose medical providers within a certain network. Choosing someone from outside the network would cause your insurance to no longer apply to your medical treatments.
- No medical necessity: Health insurance companies often like to say that a medical treatment was not medically necessary and, therefore, does not qualify for coverage. Denial can also apply if the procedure is considered to be experimental by the greater medical community. Basically, your healthcare insurance will only provide coverage for treatments that medical providers trust and for necessary reasons, nothing cosmetic.
- No referral or approval: Some medical procedures should only be completed after a referral is received from another medical professional who sees the necessity behind it. Other procedures require approval or authorization from a reviewing medical board. Failure to receive the correct referrals and approvals could void the insurance coverage of your medical treatment.
- Expired timelines: There are also common time limitations for both coverages and treatment allowances. Your claim could be denied if the proper paperwork was not provided to the insurance company in a timely manner. Or, receiving a covered treatment too late after it was first recommended could even become problematic for your health insurance claim.
How Our Attorneys Help with Your Denied Claim
Our Tulsa health insurance claim attorneys specialize in stepping in and taking over after a claim is denied. You obviously would not be filing and pursuing a health insurance claim if you believed it was erroneous or unjustified, so what reason did your insurance company have for denying it? We will thoroughly review your health insurance policy and their denial to get to the bottom of the situation.
After reviewing your policy and their reasons for denying your claim, we can:
- File an appeal: This is the first step when challenging an insurance company’s claim denial. Using our extensive legal experience, we can draft an appeal letter that explains why the insurance company was wrong to deny your claim. In many cases, we can use an appeal letter and continued negotiation to reach a fair settlement amount without needing to take the case further.
- Threaten to litigate: 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 if they do not comply and supply a settlement. At this point, the insurance company may concede to avoid the trouble of going to court.
- Litigate: The next and final step is actually taking your case to litigation, or a trial. We are ready to fight on your behalf before the court to show how the insurance company has wronged you by denying your health insurance claim. Your case could even create case law that benefits others in similar future situations.