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What You Need to Know about Health Insurance Claims

If your health insurance company refuses to pay for a medical service you’ve received or need to receive, you can and should fight back.

Private health insurance companies, like every other kind of insurance company, are in the business of making a profit, so they come up with a whole host of reasons not to pay claims, particularly expensive and recurring ones that take a relatively bigger bite of their profits.

Why You Should Appeal a Denied Claim

Studies show that approximately 18% of all in-network health insurance claims are denied, and some particularly greedy companies deny over 40% of in-network claims, not to mention out-of-network claims, which are almost always denied.

What’s worse is that consumers hardly ever appeal these decisions. In fact, less than 1/2 of 1% of healthcare consumers appeal health insurance claim denials, even though these denials are overturned following an appeal at a rate as high as 88%.

Why Do Insurers Deny Claims?

Insurance companies know these statistics. To them, it’s worth rolling the dice and denying an expensive claim – even an entirely valid one – knowing that very few people will ever go to the trouble of appealing the denial. On top of that, their risk in doing so is very low because they generally aren’t penalized for initially denying a claim that ends up being reversed, at least not until the claim has made its way through several levels of appeal. As you can see, health insurers have every incentive to deny valid but expensive claims to see if the denial sticks because most of the time it does.

How an Attorney Can Help with Your Health Insurance Claims

As with any other type of insurance claim, you’re always more likely to succeed in an appeal of a health insurance company’s denial when you’re represented by an experienced attorney. Like one of my mentors always says, everybody hates lawyers until they have an insurance claim. But for inexpensive, non-urgent, and non-recurring claims, it may make more financial sense to initiate the appeal process yourself, at least until you reach the external level of review. If you decide to start the process alone, use our Guide to Health Insurance Appeals to help you.

We Are Here to Guide You

The most important thing to remember is that if you’ve had a health insurance claim denied, file an appeal and don’t give up. As long as insurers stand to profit from denying claims, they will continue to find every reason they can to deny them. If you need help with a claim, then please reach out to Norton Health Law so we can evaluate your claim and advise you whether you should appeal the insurance company’s decision. If so, we’ll help you determine whether you should appeal the denial on your own or let our firm handle it for you.

Call us today at (434) 978-3100 or contact us online to schedule your free consultation with a friendly legal professional at our firm.

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Charlottesville, VA 22901
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