Health insurance is an essential part of life that allows us to get help with expenses that have to do with the overall cost of going to the doctor and your wellbeing. What might not seem like a huge deal, a health insurance claim denial, can lead to a ton of stress, loads of money, and time and effort that you are not willing to expend. If you are dealing with an insurance claim denial, you may want to talk to a health insurance claim denial attorney that can help argue your case.
What does a Health Insurance Claim Denial Mean?
When we go to the doctor or go to the hospital, we offer up our health insurance so that the office can bill the procedures through insurance to get either a full or partial payment. This payment is going to help reduce the amount of money that you are going to be required to spend out of pocket so that you can afford to get preventative care as well as care when you are sick or injured.
This means that when you go to the doctor or the hospital, in most cases you are not going to be paying the full price of any procedure out of pocket. Most insurance companies have a list of procedures, items and other services that they cover as well as an explanation of how much they are going to pay on that particular item. This pay schedule helps you to determine what you are going to have to pay out of pocket and can also help you determine what sort of treatment you want to have based on what you can afford.
The hospital or office that you are visiting is likely going to be able to explain to you prior to any procedure exactly what insurance they accept so that you can either continue treatment there or you can go somewhere else. So, what is an insurance claim denial? A denial is just that, the office or hospital will run the bill through the insurance company where it will either be accepted and paid out to the hospital at which time the remainder of cost will come to you in the form of a bill. It can also be denied or kicked back, and the insurance company can refuse to pay any portion of the bill.
A denial is not all that common if the procedure is deemed necessary and if you are getting treated at an office or a hospital where your insurance is accepted. If you are going to a hospital or an office where your insurance is not accepted, your denial is far more likely. A denial means that you are then responsible for paying the bill in full, even if you do not have the funds to do so.
What Can you Do About a Health Insurance Claim Denial?
The first step in any denial is to contact the health insurance company directly. This can help you to find out why the claim was denied and make sure that there is a valid reason that the claim was denied. You can talk with the company and see if there was a valid reason for denial and then move on from there. In some cases, the insurance company will tell you why the claim was denied, and you can then move forward.
If you feel that the claim was denied without reason or without merit, you can appeal to the insurance company and see if they will run the bill again or pay part of it. If this does not work, you may need to hire an attorney. A health insurance claim denial attorney is going to be able to help you figure out what you should do and start to work toward the claim being paid.
Your lawyer will help you get in contact with your doctor, with the facility and the people that did the procedure and will then help you start to justify the procedure. With any sort of denial your main goal is going to be to prove that the procedure was needed, valid and that it was covered by the insurance. In some cases, you can get your bill lowered and you can set up payment plans. In other cases, you can get a settlement to help you pay the bill and get back to your life. If your insurance claim is denied, it is the responsibility of the insurance company to let you know why the claim was denied. If they refuse, they are in breach of your agreement with them, and you can demand an explanation.
A great lawyer can make the entire process simpler and can help you to get your claims paid and get the money that you need to start healing and to go about getting your life back in order. A health insurance claim denial is not the end of the line, it is not the be all or end all and with help you can get the claim sent back through, resubmitted and even paid in many cases. Your lawyer can help you build a strong case that proves your procedure was needed and that it should be covered by your insurance.
In most cases, denials are made based on the fact that the insurance company does not see the procedure, as necessary. If your lawyer is able to help you to prove that the procedure is needed, you can then get it sent back through and get it paid out and taken care of. The right lawyer can help you get your case heard and settled so you can focus on healing.