Bozeman Health Insurance Dispute Lawyer
With the cost of health care on the rise in our country, most of us would find it challenging to receive necessary medical care if it weren’t for having insurance to help defer some of those expenses.
That’s why it can be frustrating, if you do have a health plan, to receive an explanation of benefits in the mail or your insurer’s portal letting you know that they denied your claim. That’s not the only situation you have to worry about when you have a medical plan, though.
Contact our law firm to speak with a Bozeman health insurance dispute lawyer if you’re dealing with a denied claim or any other issue so we can advise you of your legal options.
Common Causes of Medical Claims Denials
One of the most common issues that consumers with health insurance experience is claims denials. Why do they get denied? It happens because the:
- Claims reviewers determine that the procure performed was not medically necessary
- Patient received care from a provider that’s not in network with their health plan, and they don’t have out-of-network benefits
- Insurance company misclassifies procedures, claiming they don’t fall into one of the ten essential health benefits categories that must be covered by insurers per the Affordable Care Act (ACA)
- Date of service listed on the claim pre-dates when the insurance went into effect
- Claim form contained inaccuracies, such as the wrong National Provider Identifier (NPI) number, or omissions, such as the point of service (POS) code
- Doctor’s office or patient failed to get the procedure pre-certified or authorized by their insurer
- The claim was submitted by the patient or provider after the timely filing deadline lapsed
Other Potential Reasons for Disputes with Health Insurers
Claims denials specifically affect individuals who already are insured. However, they’re not the only ones who find themselves in conflict with health insurance companies. So, too, do uninsured individuals who are simply trying to secure coverage or those trying to hold on to the plan that they do have.
To this end, some more tangible examples of other issues our attorneys commonly handle on behalf of clients include:
- Prohibitions on eligibility for coverage during special enrollment periods (despite a potential subscriber having a qualifying event, including having a baby)
- Denials of insurance coverage based on having a pre-existing condition (although doing so is illegal per the ACA)
- Cancellations of health plans before a divorce is adjudicated
As you may suspect, the listing above comes nowhere close to highlighting all the potentially contentious issues insureds or those seeking to get or retain coverage may encounter.
Consider reaching out to a Bozeman health insurance dispute lawyer like ours to discuss your unique situation so we can advise you of your rights respective to it. That case review conversation is free of charge.
Possible Legal Remedies Available
All insurance companies have policy documents that outline policies and procedures for disputing claims decisions and other concerns. Generally, health insurers require you to see their internal appeals process through to completion before you can even consider filing a lawsuit.
Just keep in mind that medical plans that do require appeals generally have tight filing deadlines in place. If you blow past it, you may forfeit your right to have your position reconsidered.
In addition to having an internal appeals process, your subscriber agreement may detail a second course of action, such as an independent external review. If it does mention this, then the good news is that you will be able to have an unaffiliated party review your claim to determine if your actual insurer complied with your policy’s terms and conditions when denying your claim or making any other decision.
A lawsuit is generally the option of last resort in bad faith insurance cases like these. After all of the more conservative options like calls or letters to claims representatives, appeals, and a reassessment by an independent review organization (IRO) have been exhausted.
It’s important to know that denials at earlier stages, especially in the case of an independent review, can potentially adversely impact the outcome of a litigated case. So, you’ll certainly want to seek out the careful guidance of a skilled attorney familiar with handling legal matters like these to minimize the chances of jeopardizing the outcome of your own case.
How a Lawyer Can Help with Your Health Insurance Disagreement
If you’re at the point where you’ve begun seeking out legal counsel, then you’re likely doing so because you’re at your wit’s end in dealing with them, and you’re ready for someone who does understand how to navigate issues like these to help you get a resolution, reach out to us.
While no Bozeman health insurance dispute lawyer will promise any particular outcome, one promise we can make to you is to impart any knowledge we have about dealing with medical plans in Montana to you in hopes that it can help you resolve your lingering concerns.
And, if you decide to hire one of our firm’s attorneys, we’ll offer to have you sign a Health Insurance Portability and Accountability Act (HIPAA) and any other necessary documents that will allow us to handle as much communication as possible with your insurer and others on your behalf.
This will, hopefully, limit the amount of stress you’re subjected to and help you get a resolution to your concerns more expeditiously.
Here at Western Justice Associates, PLLC, we don’t believe that cost should be a barrier to learning about your rights when legal exposure and, consequently, your financial future is on the line. That’s why we don’t charge for your initial meeting with legal counsel, and we otherwise work on a contingency basis, meaning we collect a percentage of any amount we recover for you.
So, if you’re ready to get answers and a resolution to your problems with a health insurer, contact our Bozeman law office now to speak with a lawyer.