Denied Mental Health Insurance Claim? We Can Help

mental health insurance lawyerMental health is just as important as physical health; failing to meet your mental health needs can lead to serious consequences, including death. In the United States, suicide is the tenth leading cause of death. Despite the serious health risks associated with untreated mental health issues, insurance companies deny mental health insurance claims with alarming regularity. They do this knowing that many individuals are unaware of their rights and will not fight the denial. However, there are many regulations that govern the health insurance industry. If you have had a claim denied in San Francisco, you may be able to fight back and get the care you deserve.

California’s Mental Health Parity Act

Under the California Health & Safety Code, health insurance companies in San Jose and other communities must not limit mental health care options any more than they limit physical health claims. This is applicable to all areas of treatment, from diagnosis and medications to inpatient care and outpatient treatment. Legally, insurance companies regulated by this law must provide treatment for bipolar disorder, anorexia, bulimia, obsessive compulsive disorder, depressive disorders, and many other mental health issues.

This law applies to state-regulated health care plans. Medicare, VA programs, self-funded plans, and Medi-Cal are not included. This does not mean that they can deny your mental health insurance claim without reason. Many Bay Area insurance plans are governed by federal parity laws.

What to Do After a Denied Claim

After you receive a notice of denied mental health insurance benefits, you should act quickly to protect your rights, create a paper trail, and hold the company accountable. Take these steps after a claim is denied:

  • Write down the details of your claim. Make sure you have the claim number, care provider, date of service, date of denial, and reason for denial.
  • Check your plan paperwork. Keep a copy of your health insurance paperwork. The paperwork should outline what care the plan does cover and any specific excluded areas.
  • Contact a mental health insurance lawyer. You can appeal the insurance company’s decision to deny your claim. However, remember that you are going against an industry with lots of resources. They make money by denying claims, and they will not make it easy to hold them accountable. Working with a health insurance lawyer who can navigate the system minimizes your stress and helps your chances of success.

Navigating the Appeals Process

While insurance companies must legally make information on the appeals process accessible to subscribers, they are also very good at it making it overwhelming and difficult to understand. As a result, many subscribers give up before the fight even starts. If your claim is denied, you need to learn about the appeals process. We have worked with many large and small insurance companies, so we are in a great position to help you with the appeals process.

Your insurance company’s appeals process should be available in your initial enrollment paperwork and on their website. Look for information on how many times you can appeal, what type of documentation the insurance company needs, whether external appeals are available, and appeals deadlines. Providing this information to your health care insurance attorney can save time.

Be ready to fight for your right to mental health care. You pay your premiums, and it is only fair that the insurance company fulfills their obligations. Until this systemic problem is fixed—mental health care claim denials are reportedly twice as common as general medical care claim denials—it is important to fight on an individual level.

How We Can Help If You Have Been Denied Mental Health Insurance Benefits

At DL Law Group, we are passionate about consumers’ rights. Health insurance companies have a duty to follow the terms of their policies and provide consumers with the care they pay for with their monthly premiums. When they fail to fulfill their obligations, we are ready to hold them accountable. We will use a number of techniques, including:

  • Looking for violations of parity laws. If your company is more stringent with mental health claims than physical health claims, they could be in violation of state or federal laws.
  • Utilizing current evidence and resources. Insurance companies do not often pay for care that is not evidence-based. We will use our extensive knowledge of current research to demonstrate that you sought evidence-based care that should be paid for by insurance.
  • Proving medical necessity. Our team will work hard to prove that the care you received was medically necessary. We may utilize your own words and statements, statements from your care providers, or diagnostic criteria to demonstrate that your care improves your quality of life.

Do Not Let Denied Mental Health Insurance Benefits Keep You from Getting the Care You Deserve

If you have mental health struggles, fighting insurance companies can increase your stress and hinder your healing process. Let us help. Get started and reach out to DL Law Group at (415) 678-5050
we look forward to assisting you.