Los Angeles Anthem Denial of Back Surgery Lawyer
As many as eight out of 10 Americans experience back pain at some point in their lives. Out of those, about five percent will need surgery to correct the problem.
If you are a part of this five percent, you likely anticipate that your insurance would cover the surgery that your doctor recommends. After all, you have paid your premiums on time and in full, and you have gotten a recommendation from a doctor within your network. This is why it can be so surprising when you find out Anthem is denying your back surgery claim.
A denial of your claim can make a painful and stressful time even more worrisome. If you do not want to handle the stress and the logistics of dealing with a denied claim on your own, a Los Angeles Anthem denial of back surgery lawyer may be able to help.
Tips for Getting a Claim Approved
There are steps insured individuals can take to possibly improve the chances that their claim or appeal will be approved. For instance, it could be critical to play by the insurance companies rules. This can include ensuring that referrals and pre-approvals are obtained when required by their insurance plan.
Proving medical necessity to Anthem can be easier when the insured doctor can communicate by phone or in writing as to the need for care. In addition, prior to submitting a claim or have a treatment, policyholders should double-check their policy to find out what might or might not be covered. If necessary, they should seek clarification from Anthem or even request it in writing to protect themselves.
Insurance Company Responsibilities
Under California Insurance Code §790.03, Anthem has many responsibilities when it comes to handling claims and dealing with claimants. Some of these include:
- Accurately representing insurance policy provisions relating to the coverage at issue
- Adopting and implementing reasonable standards for prompt investigation and processing of claims
- Promptly affirming or denying coverage in a timely manner
- Informing insured parties how to appeal a denied claim
- Settling claims promptly
- Providing a prompt and reasonable explanation of the basis relied on in the insurance policy, in relation to the facts or applicable law, for the denial of a claim or for the offer of a compromise settlement
Getting Legal Help from a Los Angeles Anthem Denial of Back Surgery Attorney
Unfortunately, according to the Consumers Union, 51 percent of claimants in California did not take action in relation to their claim denial because they did not think it would make a difference. Although paying your own claim or skipping a doctor-recommended surgery may seem like the easiest way out, there may be other options in your situation.
A Los Angeles Anthem denial of back surgery lawyer may be able to assist in getting your claim covered. Whether by walking you through the steps of an appeal and ensuring that your paperwork is complete or by taking Anthem to court, an experienced insurance attorney may be able to help you. Call today to find out what your rights allow for after a denied back surgery claim.