How to Appeal Insurance Company for Denied Health Care Services

While California law requires health insurance companies use good faith when they approve and deny coverage for health services, this is not always followed.

Some insurance companies may use unfair or deceptive insurance claim practices, which in turn causes frustration on the part of deprived policyholders.

Some examples of health services denied in bad faith ,include autism treatment, mental health treatment, skin removal surgery after significant weight loss or weight loss surgery, and proton therapy.

If you think your California insurance company, such as Anthem Blue Cross, has refused to cover a health service you need, you may want to consider filing an appeal.

How to Appeal a Rejected Insurance Claim

Appealing insurance claim denials with a California insurance company such as Anthem Blue Cross can be a long uphill battle, but for many people it is a necessary step in receiving the coverage owed to them.

When a person has had an insurance claim denied there are several steps they should take in order to hopefully appeal the insurance company’s decision.

First, the insured should review their policy paperwork and benefits plan. These documents will explicitly state what types of claims are covered and what are not. The insurance claim denial letter sent from the insurance company will also tell the insured why the claim was initially denied.

Once information is gathered about the heath care policy, the policy holder should call his or her insurance company. During this phone call he or she should ask the company to state why the claim was denied, ask whether it was due to a billing error or missing information, and ask how the appeal process works with an insurance company such as Anthem Blue Cross.

Most appeals have time limitations so it is important to learn any deadlines that may be approaching. Records should be kept of the name of the person talked to, the date, and what was determined or decided during the phone call.

If the claim was denied due to a medical billing error or missing information, the policy holder should contact his or her doctor and have the necessary information updated and resubmitted to the insurance company.

If the insurance company continues to refuse to provide the needed coverage, the insured may file an appeal. The Affordable Care Act allows the claim to be reviewed by the insurance company and an external third party review company.

It is important that the policy holder follow the appropriate appeal procedure designated by his or her insurance company. Each insurance company’s appeals process may vary slightly. Generally a complaint is first filed for internal review and an agent or agents, other than those that reviewed the original claim, give the claim a second look.

If the claim is still denied, the policy holder will have the option of having their claim reviewed by an external third party. In some cases the insurance company is entitled to more than one internal review before a third party can be brought in.

Bad Faith Insurance Lawsuits

Insurance claim attorneys are currently looking for potential plaintiffs to bring bad faith insurance lawsuits against various insurance companies such as Anthem Blue Cross. Prospective plaintiffs may include persons who have recently had a California insurance company refuse to cover or stop covering necessary medical treatment.

Bad faith insurance lawsuits may help claimants receive payments they were wrongfully denied. The decision to file an health service denial lawsuit is a decision that should be made with the advice of a legal professional. It’s important to pay attention to timelines and due dates when filing an insurance claim appeal so that a claim is not blocked from the appeal process due to untimely action.

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.

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