Missoula Health Insurance Dispute Lawyer

How Private and Group Health Insurance Disputes Vary

As you may be aware, aside from government-sponsored insurance programs, there are also private plans, also known as individual and group plans, that are offered to workers by their employer.

In the case of employment-related health plans, they’re governed by a federal law called the Employee Retirement Income Securities Act (ERISA), which establishes certain minimum standards that protect individuals enrolled in these plans.

While those exact same terms may not correspond to those with individual plans, the insurance companies people who secure their own coverage from are legally obligated to:

• Thoroughly investigate claims before making a decision about whether to approve (and pay) them or deny them (and decline to make a payout)
• Promptly process and remit payments on approved claims
• Provide a reasoning for any claims denials they make

If a private health insurer fails to do any of the aforementioned, then it might be said that their actions rise to the level of insurance bad faith, which is a prohibited practice per Montana law.

When Health Insurers’ Claims Denials Violate Montana Law

Since denials of claims are one of the most common tactics health insurers use when trying to keep their costs low, let’s look at how this practice often unfolds. It often happens when claimants seek coverage for the following:

• A multi-part treatment regimen for a chronic medical condition, cancer included
• Procedures requiring the use of emergent technology or surgical techniques
• Rehabilitative care at a residential facility
• Further testing that may help doctors hone in on a patient’s diagnosis
• Newly released or high-powered, costly medications
• A long-term hospital stay
• At-home medical equipment or assistive devices

While we’d like to say “the sky’s the limit” in terms of what health insurance companies are willing to pay for and thus they will approve claims for virtually anything that has the potential of helping you, that’s certainly not the case as you can tell from looking at examples above of the care, treatments, medications, etc. they deny.

When To Seek Help From a Missoula Health Insurance Dispute Attorney

So, you’ve tried reaching out to your health insurance company, asking why they paid less than you expected or altogether denied your claim. You didn’t get the right answers, and you filed an appeal with them.

You might have even gone as far as following up with the Montana Commissioner of Securities & Insurance without any resolution as well. Whether you’ve already been through the paces described above or not, consider reaching out to a Missoula health insurance dispute lawyer to learn what approach you should take next.

We know that you’ve likely already put more money, time, and energy into resolving your health insurance woes than you should have.

The good news is that you won’t incur any added costs by consulting with one of our attorneys, as our consultations are free. And, since we work on a contingency basis, you won’t have any attorney’s fees unless we secure a settlement on your behalf.

So, let’s talk now about your health insurance issues and help you decide what path to go down to resolve them. A statute of limitations applies to cases like these, so be sure to act fast.