When a claim for benefits is denied, attorneys for denied medical claim by insurance company are ready to help.
Medical Insurance Denied Claims
The first thing policyholders should do when claims for medical benefits are denied is to ask the insurance company to provide them with the reasons for the decision. The insurance company is legally required to provide you with the following information:
- A detailed explanation of the reason why your claim was denied.
- Reference to the policy clause that sets out the exclusion for the service being denied.
- The full name, title and medical license number of the person who made the decision to deny the claim. The state the individual is licensed to practice in must also be listed.
- If alternate services or treatments are covered under your policy, these must be presented in the letter.
- Instructions for starting an appeal of the insurer's decision must accompany the letter. The insurer must tell you what the time limits for filing an appeal are and whether you must do so in writing. The company must also give you the name and phone number of a company representative.
- Instructions for taking the appeal to an outside authority if the insurer denies it.
Find Attorneys for Denied Medical Claim by Insurance Company
When you need to find an attorney to represent you because your medical claim has been denied, you have a few options:
- Contact your State Bar Association to ask for a referral to an attorney who specializes in this area.
- Look for an attorney online.
- Check your local phone directory.
- Ask friends or family members if they can recommend someone.
When You Meet With an Attorney
You should be able to meet briefly with an attorney for a consultation at no charge or for a minimal fee. Take the letter you received from the insurance company with you, along with a copy of your insurance policy. It is a good idea to write down all the details that you can remember about the services you made a claim for. Start with the diagnosis and your doctor's recommendation about treatment. Tell the attorney what medical procedures you had performed and when the request for payment was forwarded to the insurance company.
Put It in Writing
It's a good idea to take the time to write everything down and then give the information to the attorney to review. Taking this step means you are less likely to forget something and it will take less time for the attorney to read through what you have written than if you try to explain everything verbally.
Interview the Attorney
When you meet with the attorney remember that you are looking for someone who you will feel comfortable with. The attorney you choose will be representing your interests in negotiating with the insurance company. If you meet with someone and you don't think that you would be able to work well together, move on to another attorney.
After You Find an Attorney
Once you find a suitable attorney, leave any communication with the insurer up to your lawyer to handle. He or she is acting as your representative, and will look out for your interests.
Your lawyer will give you advice about how to proceed and look after filing the appeal with the insurance company for you. They are trained to deal with insurers and may be able to get the company to pay your claim.
Take Your Attorney's Advice
If the lawyer reviews your policy along with the letter from the insurance company outlining the reasons for denying the claim and any additional information you can provide, and recommends that you accept the denial of benefits, you can either accept this advice or instead choose to hire a different attorney to represent you.