Los Angeles Anthem Surgery Denial Lawyer
You saw a doctor for a medical problem or pain you were experiencing. Your doctor recommended a surgery. You also pay your healthcare premiums according to your policy documents. However, Anthem Blue Cross Blue Shield is denying your claim for surgery.
You may feel trapped, frustrated, or even hopeless. According to the Consumers Union, as many as 88 percent of insured individuals who are denied coverage on a medical claim end up paying some or all of their medical bills themselves.
However, the good news is that you have other options besides immediately reaching for your checkbook. One of these options is contacting a Los Angeles Anthem surgery denial lawyer. A dedicated attorney may be able to help you get your claim covered in a number of different ways.
Why are Surgery Claims Denied?
The Physicians for National Health Program reports that 26 percent of all healthcare claims in California are denied. Reasons for claim denial can vary widely, depending on the insured party, their policy, their healthcare providers, and what the treatment or procedure is. Common reasons for denial include:
- The patient went out-of-network to receive medical care instead of seeing a provider who was contracted with the insurance carrier
- The insurance carrier determined that the services were not medically necessary
- The services were determined to be experimental or investigational
- The plan does not cover the services in the claim (i.e. cosmetic procedures)
- Typographical or clerical errors
- A required referral or preauthorization is incomplete
- The claim was not submitted in time
It is not unheard of for Anthem to use confusing language buried somewhere in the insurance policy, or to distort the nature of the policy, in order to deny a claim and protect their bottom line. When a claim is denied and the affected policyholder believes it should not have been or is confused about the rationale behind their denial, they have many options. One of these options is to hire an Anthem surgery denial lawyer in Los Angeles to help them with contesting the decision.
California Insurance Laws
Fortunately, insurance companies such as Anthem Blue Cross are legally bound to take certain actions when dealing with claims.
By law, Anthem is required to attempt in good faith to review requests for coverage and provide a fair, full and objective review by competent doctors before making denials for lack of medical necessity. They also may not misrepresent a claimant’s facts or the provisions of the insurance policy related to any coverage that is being contested.
Speak with a Los Angeles Anthem Surgery Denial Attorney Today
Do not be a part of the 88 percent of insured individuals who end up simply paying their medical bills themselves. A Los Angeles Anthem surgery denial lawyer may be able to help you make sense of your denial and why it may have been unfair.
Experienced attorneys are well-versed in California insurance laws and what excuses insurance companies use to deny claims, and their job, if retained, is to pursue justice for you. Call today to schedule a consultation and start working on your claim.