Healthcare Insurance Bad Faith: What You Can Do
When you have fallen ill and have health insurance, you know you’re in luck. Your claims will be handled properly because you have an insurance company who cares about you and recovering from your illness… right? Unfortunately, even though insurance companies are expected to act in good faith at all times, this doesn’t always happen like we expect it to. You purchase health insurance for you and your entire family so that you can receive the care you deserve. However, when your insurance claim isn’t covered and you know it’s supposed to be, you could find yourself in the middle of a bad faith insurance case and wonder what actions you can take to protect your rights.
The Rise of Bad Faith in Health Insurance Claims
Unfortunately, bad faith in insurance claims happens far too often for us to live without worry. You may think that you have great insurance coverage but have come to find out that your insurance company is not playing by the rules and covering you for a variety of different aspects. With frequency over the years, we have seen many insurers deny claims for coverage even when they weren’t supposed to. The unfortunate fact remains: When it comes to insurance, the policyholder loses. In many states, auto and property insurance companies are fined when they deny claims in bad faith. Unfortunately, little stands to protect us when an insurance company does the same thing to us and we are left with few legal remedies.
Those who enter into these cases understand that the big-name insurance companies fight until the very end when it comes to denying a claim so that they can be incentivized for doing so. This practice is against the law in many cases but pushes the policyholder to pay for their expenses out-of-pocket. Knowing that they might not be successful in a claim, the policyholder will do so, paying the bills themselves even though the healthcare insurance company definitely should have paid for it. This is due to the fact that many people are aware that dealing with insurance companies is not only time-consuming but can cost a lot of money – money that a patient might not have.
Common Reasons for a Health Insurance Denial
The truth is, when a denial does occur by the health insurance company, it doesn’t always mean that bad faith has occurred. Most of the time, the insurance company themselves or the hospital can walk you through the process and help you understand why your claim has been denied in some capacity. If you have been denied, you will receive the reasons so that you can understand how to move forward. Some of the reasons for denials every year include:
- Procedures were not covered by the policy
- A procedure is experimental or cosmetic in nature
- A referral was required
- You used an out-of-network provider for services
- There were typographical errors
- There were policy limitations
Let’s say that a health insurance company has denied your coverage for one of the stated reasons. When your insurer refuses to pay a claim, you have the ability to respond to the denial. Perhaps you have arguments against the decision because you believe that they are acting in bad faith. Bad faith happens in many ways when it comes to insurance companies. Perhaps the insurer fabricated evidence, refused to accept evidence, refused to conduct an investigation even though it was necessary, unreasonably delayed an investigation, or any other grounds. You may have to act quickly because there is a statute of limitations on many of these cases, which means that you might not have much time to work on your case and the denial.
Burden of Proof
A burden of proof lies with the insurance company when you have started a claim for bad faith. The insurance company must be able to prove that they acted appropriately and denied your claim within good reason. You want to ensure that you have a strong case before you move forward and make your claim, which is why we will stand by your side to assert the following aspects:
- We want to make sure that you know your policy from front to back and what you should do in order to be approved for treatment. If you have to gain a referral to see a doctor, you want to ensure that you are doing so.
- You want to keep all paperwork related to your policy and make sure that you never throw this information out.
- You want to understand the ins and outs of your lawsuit. This means Googling bad faith lawsuits in your area, checking the laws in your area, and so much more. Go to this claim with knowledge.
What We Can Do For You
As your attorney in your bad faith insurance claim, we want to make sure that you understand your rights and can move forward in this difficult time. Unfortunately, many people fall victim to these cases every year when their insurance company will not protect them and cover their medical aspects even though they are supposed to. We have handled various disputes when it comes to health insurance policies in 23 years. Many of these stem from people who have pre-existing conditions, exclusion periods or undergo experimental care that is not covered by their insurance. Most of the time, an insurer will deny somebody’s claim even though they have no right to do so.
You want to make sure that your health insurance is being seen as an investment instead of paying extra for things that you shouldn’t have to. At the McGuire Law Firm, we want to stand by your side every step of the way as you stand up to your insurance company and work toward the medical coverage you deserve in your time of need. Call us today so we can speak to you about your case at 888-352-0624.