Our Health Insurance Attorneys Explain Options for Payment Issues
Insurance payment problems are a major issue facing medical practitioners. Patients count on health insurance companies to cover benefits for important services. However, it can sometimes be extremely difficult to obtain insurance coverage after receiving medical care. Insurance companies may underpay claims or fail to pay claims. This is especially true for mental health care services. People seeking treatment for mental health services may run into issues getting their insurance providers to cover treatment. As a result, patients may not be able to cover the cost of treatment. Medical practitioners may be unable to recover payment for services from the patient or insurance company.
If you are a medical practitioner, hospital or clinic, then you may be able to hold an insurance company accountable for nonpayment or underpayment. Our San Francisco health insurance attorneys could help you review your possible legal options.
What Are Common Reasons for Insurance Denials?
Insurance companies may deny patient claims for a number of reasons. Some of the most common reasons include:
- The service is not covered. An insurer might deny a claim if the policy did not offer coverage for the service rendered.
- The treatment was not necessary. Insurance companies may claim a patient did not need a specific treatment. Additionally, an insurance company may deny a claim for an experimental treatment.
- The insurer is acting in bad faith. Insurers may simply make up a reason to not pay a claim. If an insurer is refusing to pay a valid claim, then it could be insurance bad faith.
- Mistakes during the filing process. Mistakes made during the filing process can result in a claim denial.
Contact us for a free consultation. During a consultation, we can explain whether it would be possible to hold an insurance company accountable for refusing to pay a claim.
What Is Insurance Bad Faith?
As a very general definition, insurance bad faith is where an insurance provider engages in unfair or unreasonable practices during the claims process. Insurance companies must act in good faith with their policyholders. Examples of insurance bad faith may include:
- Denying coverage without a sufficient reason;
- Charging higher premiums after a patient files a claim;
- Delaying payment for services rendered;
- Misrepresenting coverage to avoid paying a valid claim;
- Canceling or failing to renew a policy without cause.
These are only a few examples of what might constitute insurance bad faith in California.
Insurance Claim Denials and Mental Health Parity
Under federal and state parity laws, insurance companies must provide equal coverage for mental and physical health conditions. However, insurance providers may still attempt to deny a claim for mental health services.
If an insurer is refusing to pay a mental health claim, then it may be a violation of parity laws. We encourage you to contact us to determine whether it would be possible to hold the insurer accountable for nonpayment or underpayment.
Can I Sue an Insurance Provider?
Medical practitioners may have a few options for resolving insurance payment issues. If you are a medical practitioner facing under or nonpayment, then you may be able to appeal with the insurance company. The patient may also be able to pay for services. Additionally, if an insurance company is wrongfully demanding payment, then you may have legal options to resolve the situation.
You may have the option to file a lawsuit against the insurance provider. Whether this would be a good idea for your specific case depends on the circumstances. Each case is going to be different. Contact us for more information.
Contact Our San Francisco Health Insurance Attorneys
The health insurance attorneys at DL Law Group can negotiate a settlement on your behalf. If necessary, we can take additional steps to ensure the insurance provider pays for services.
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