Questions answered from filing a claim to hiring a health insurance attorney

Picture of claim form being read by San Francisco Bay Area health insurance lawyerHealth insurance is a crucial component of the employee benefits package offered through your employer. Unfortunately, however, the process of filing claims and collecting benefits payments can – and often is – complicated and confusing. Health insurance is a crucial component of the employee benefits package offered through your employer. Unfortunately, however, the process of filing claims and collecting benefits payments can – and often is – complicated and confusing.

Insurance companies and employers use this vulnerability to take advantage of policyholders to deny deserved coverage and payments. If you feel you are being treated unfairly, partnering with a California health insurance claims attorney at DL Law Group can help you collect the financial compensation you deserve. Insurance companies and employers use this vulnerability to take advantage of policyholders to deny deserved coverage and payments. If you feel you are being treated unfairly, partnering with a California health insurance claims attorney at DL Law Group can help you collect the financial compensation you deserve.

Health Insurance FAQs

  1. I need to file a claim, what do I do?
  2. When would my health insurance claim denied?
  3. What do I do if my insurance denies my claim?
  4. What is an insurance bad faith claim?
  5. What do I do if UnumProvident denies my claim?
  6. What is ERISA?
  7. Do I need to hire a health insurance attorney to file a claim?
  8. Does DL Law Group have qualified health insurance lawyers in the San Francisco Bay Area?

I need to file a claim, what do I do?

Health insurance claims recover out-of-pocket medical expenses not automatically billed. A detailed claim form must be submitted to your insurance company, who will then determine what expenses from the claim they will cover. This is how you will communicate every aspect of your claim, so the more detailed you are, the better your chances of having the claim accepted in full.Before submitting the completed claim form, it is important to make a copy of the claim and all other related documents for your records.
Health insurance claims recover out-of-pocket medical expenses not automatically billed. A detailed claim form must be submitted to your insurance company, who will then determine what expenses from the claim they will cover. This is how you will communicate every aspect of your claim, so the more detailed you are, the better your chances of having the claim accepted in full.Before submitting the completed claim form, it is important to make a copy of the claim and all other related documents for your records.

When would my health insurance claim denied?

Insurance companies are large entities that will look for ways to deny your claim. Some of the most common reasons why claims get denied include:

  • Liability: Insurance companies will challenge whether they are responsible to pay your claim based on the cause of an accident or the resulting personal injuries. Some will go to great lengths to try to prove the policy does not cover the recovery of your losses.
  • Charges are not covered: Exclusions listed in every insurance policy can be complicated and confusing to understand, which is by design. An experienced health insurance lawyer can help sort out through legalities to determine if the denial was valid.
  • Pre-authorization: Certain medical procedures need referrals or per-authorization before coverage is approval in your plan
  • Failure to notify: If your insurance company is not notified of an accident with enough time, they can claim they were not given enough time to investigate your case.

What do I do if my insurance denies my claim?

You pay for health insurance so that when you get sick or hurt, your expenses are covered. A denied insurance claim can leave you frustrated and looking for a place to turn. The first thing to understand is that there are options in place that afford you the opportunity to present your case through the insurance claims appeals process.Filing a health insurance claim appeal is a complicated and confusing process. A detailed account of all records involving the claim will need to include related medical bill receipts, which is why it is important to always keep detailed records. If you feel the denial is unjustified, seek the consultation and representation from a California health insurance lawyer at DL Law Group.

What is an insurance bad faith claim?

Insurance companies must operate with a duty of good faith to the people they insure, meaning that when you need to recover legitimate medical expenses, they pay them. Unfortunately, insurance companies often fail to live up to the mandates of the policy.Not every denied claim that involves acts of bad faith, though some insurance companies will do whatever they can to avoid making payments. There are signs you have been a victim of an act of insurance bad faith, including:

  • Unreasonable claim denial
  • Claim not properly investigated
  • Settlement offer is far less than the claim outlines
  • Excessive evidence, document, and payment requests

What do I do if UnumProvident denies my claim?

Unum Group, formerly known as UnumProvident, is amongst the largest disability insurers in the country. A reputation for bad practices has followed the name change. Unum has a tendency to unfairly deny and underpay claims, as well as delay the process as long as legally allowed.Policyholders denied a short-term or long-term disability claim from Unum should not even attempt to go it alone. Disputes with Unum, and its subsidiaries like Paul Revere and Provident, require professional representation by an experienced health insurance denial attorney specializing in bad faith insurance cases.

An aggressive California health insurance claims attorney at DL Law Group works with policyholders the San Francisco Bay Area to hold Unum and other large insurance carriers responsible for unfair, unethical, and unlawful acts. Health insurance lawyers with DL Law Group have recovered millions of dollars in disability benefits for those unfairly treated by Unum Group.

What is ERISA?

The Employee Retirement Income Security Act of 1974, or ERISA, protects workers with employer-sponsored insurance benefit plans. Congress set minimum standards for private benefit packages to help ensure policyholders have their covered medical bills taken care of.Private insurance companies that administer employee insurance policies are regulated by ERISA laws. A serious injury or illness may qualify you to file a short-term or long-term disability ERISA claim.

Do I need to hire a health insurance attorney to file a claim?

If the system is working as it should, there would be no need to hire a health insurance lawyer to file a claim to recover expenses related to an injury or illness. Most simple cases are processed without incident or question, and facilitated without the assistance of a health insurance claims attorney.Unfortunately, big insurance companies sometimes use unfair and unethical practices to prevent you from collecting the compensation you deserve. An experienced health insurance denial attorney can help determine the legalities surrounding your case, and work on your behalf to get your claim approved.

Does DL Law Group have qualified health insurance lawyers in the San Francisco Bay Area?

DL Law Group is a highly respected California firm dedicated to helping insurance policyholders with insurance claims and appeals in San Francisco, San Jose, and the rest of the Bay Area. Our health insurance claims attorneys have recovered millions of dollars fighting for the rights of those with independent and ERISA insurance plans.Are you having trouble filing a health insurance claim? Has your claim been denied by an act of bad faith by your insurance company? If so, call the California insurance law specialists at DL Law today at (415) 678-5050 to schedule a free consultation about your health insurance claims case.