Denied Health Claim at a Los Angeles Hospital

Page Contents: 

• Lawyer Fighting Unjustly Denied Health Claims at Claremont and Pasadena Medical Facilities
• Why Do Health Insurance Companies Deny Medically Necessary Care?

Lawyer Fighting Unjustly Denied Health Claims at Claremont and Pasadena Medical Facilities

Health insurance companies play a significant role in providing coverage for medical treatments, but there are instances where they may improperly deny claims for essential services involving hospitals and other medical facilities. These denials can stem from various reasons, such as disputing the medical necessity of a treatment, claiming insufficient documentation, or selectively interpreting policy terms and conditions. This practice can leave patients facing significant financial burdens and create delays in receiving necessary care. 

Has your health insurance claim involving care at a hospital or medical facility been unjustifiably denied? The Law Offices of Scott Glovsky can help. We are familiar with the strategies insurance companies use to deny, delay, and underpay. Our skilled lawyer can help enforce your rights, push to hold your insurance provider accountable, and work to get you the treatments you need. We have astrong track record of prevailing against insurance companies and delivering real results for our clients. When you work with our team, you can expect personalized advocacy and compassionate support every step of the way.

Our experienced attorney is prepared to assist you with denied claims involving:

• Emergency rooms
• Inpatient skilled nursing rehabilitation
• Inpatient treatment
• Long-term care
• Out-of-network care
• Partial hospitalization
• Residential treatment centers
• Intensive outpatient programs

If you have received a denied health claim at a Los Angeles hospital or medical facility, don’t wait to schedule a free case evaluation to explore your legal options. Call (626) 323-8351 or contact us online today! Se habla español.

Why Do Health Insurance Companies Deny Medically Necessary Care?

Health insurance companies sometimes attempt to deny medically necessary care to control costs and maximize profits. While insurance exists to provide financial support for healthcare expenses, these companies often rely on technicalities, vague policy language, or selective interpretation of medical records to justify denying claims. This not only places significant stress on patients but can also delay critical care, which can potentially worsen medical conditions.

Here are some of the common strategies that insurance companies use to deny, delay, or underpay medically necessary care at hospitals and other medical facilities:

• Claiming the treatment is experimental or investigational. Insurance companies may argue that a treatment or procedure is experimental or investigational, even if it is widely accepted within the medical community. They often rely on outdated research or narrowly interpret medical guidelines to dispute the efficacy of the recommended care.
• Stating the treatment is not medically necessary. This excuse often stems from the insurer's internal review processes, which may contradict the healthcare provider's diagnosis or recommendations based on the patient's specific condition.
• Pointing to documentation issues. Missing or incomplete documentation from the healthcare provider is frequently cited as a reason to deny claims. Insurance companies will often place the burden on the patient or provider to rectify these issues, delaying treatment or reimbursement.
• Refusing out-of-network coverage. If the provider or facility is out of the insurer's network, the company might deny the claim, even in urgent or emergency situations where in-network options are not feasible. This tactic forces patients into a challenging position of navigating network restrictions at the worst possible moment.
• Imposing preauthorization requirements. Many insurers deny claims by stating that prior authorization was not obtained for the procedure, even if obtaining preauthorization was impractical due to the urgency of the situation.
• Citing policy exclusions. Insurance policies often contain exclusions for specific treatments, procedures, or conditions. Insurers may use these exclusions to deny coverage, even when the language in the policy is ambiguous or when the treatment is standard care for the condition.
• Contesting the care provider’s qualifications. Occasionally, insurers will challenge the qualifications of the healthcare provider delivering treatment, arguing that they are not adequately certified or experienced to perform the procedure, regardless of their actual expertise.

Attorney Scott Glovsky used to represent insurance companies in bad-faith cases. Now, he and his team fight for policyholders. We may be able to help you get the treatment you need if you have received a denied health claim at a Los Angeles hospital or medical facility. 

At The Law Offices of Scott Glovsky, we know how insurance companies operate and can leverage that knowledge to provide solutions-driven representation. Schedule your free consultation by calling (626) 323-8351 or contacting us online today.