Dynamic Accident Lawyers: How to Appeal a Bad Faith Insurance Claim Denial?

Patients who have a valid claim denied by an insurance company have the right to appeal the decision in order get their medical expenses covered.

Under the Affordable Care Act, insurance companies must explain why a medical claim was denied and patients have up to six months to get the decision reversed.

The personal finance website nerdwallet.com has offered several tips on the best course of action when it comes to appealing an insurance claim denial.

Appealing Insurance Claim Denial

Find out why the claim was denied: Understanding why the insurance company decided to deny your claim is your legal right. Often times, insurance companies will use a code on the explanation of benefits form to explain either the approval or denial of the medical claim. Patients who are still unsure why it was denied may call the insurance company to get an explanation.

Troubleshoot any simple problems: Occasionally an insurance claim denial comes because of a data-entry error. This could include a wrong ID number, misspelled name or inaccurate date of service. Patients who have been denied an insurance claim should look over the denial form carefully to see if there were any errors that can be easily fixed.

Collect evidence: Any relevant documents should be gathered to prove the claim was medically necessary. This could include medical history, doctor referrals and even prescription information.

Submit an appeals form: While patients who have been denied insurance coverage for a valid claim can always write an appeals letter, it is often processed faster if patients use the official insurance company’s appeal form. If you are unsure where to find the form, contact your insurance company to find out how to file an appeal.

Document the appeals process: Make sure to keep notes of all the things you did to reverse the claim denial. Keep notes during phone conversations with your insurance company including things such as the name and title of the person you speak with. Patients should also ask the company for both the call reference number and document image number.

Follow-up with the insurance company: Find out how long a typical appeal takes to be processed and make sure to call back after that amount of time to check on the status.

Get the help you need: NerdWallet.com offers free consultations with medical billing advocates. These professionals can often find the source of the error and give you information on how to deal appropriately with the insurance company.

Take legal action: Those patients who have exhausted all methods of getting the insurance coverage they need, may want to consider taking legal action against the insurance company. A bad faith insurance lawyer can offer a free case evaluation to see if you have legal claim.

Bad Faith Insurance Class Action Lawsuit Investigation

A bad faith insurance claim denial class action lawsuit investigation has been launched after numerous allegations from California insurance policyholders that valid insurance claims are being denied.

If a California insurance company has denied your claim by using bad faith tactics, you may have legal claim.

Join a Free California Bad Faith Insurance Lawsuit Investigation

A bad faith lawsuit investigation has been launched into allegations that some California insurance companies are refusing to pay valid medical claims or offering to pay far less than the claim is worth. Some of the companies being investigated for potential violations include:

Aetna
Anthem Blue Cross
Blue Cross of California
Blue Shield of California
Cigna
Health Net
Kaiser
Secured Horizons
United Healthcare
WellPoint
Others

If you or a loved one were denied coverage for autism treatment, mental health treatment, plastic surgery skin removal after weight loss, proton therapy for cancer, or some other medically necessary treatment, you may have a legal claim.

Get a Free Case Evaluation Now

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