Health Insurance

Insurance companies are aware that many individuals will not contest a health insurance claim denial, even if they feel it is wrong, because they do not think they have the resources to stand up to the Insurance Company.

What should I do if my Health Insurance claim is denied?

You do not have to accept a denial from your health insurance carrier as the final word on your health Insurance claim; however, if you decide to pursue your claim further, after the insurance carrier has denied it, you must not waste any time doing so, because your policy may contain certain deadlines for pursuing your claim.

How should I proceed?

Prior to making an appointment with the attorney, it is important that you prepare for the consultation by gathering and organizing your evidence.

What evidence will I need?

1. Get the denial in writing. You have the right to a written denial letter from the insurance company which includes disclosure of the basis for denying your claim. This letter is most important to the attorney if your case is to be pursued.

2. The terms and conditions of the health policy. This is not just the sheet that discloses your coverages, or the promotional materials which you receive from your employer, but the actual terms and conditions of the policy, which should have been provided to you when you signed up for the policy. If you do not have a copy, make a written request to the insurance carrier for a copy. Usually, the best person to write would be the one who denied your claim.

3. Medical records. It is most important that you obtain as much of your medical records as possible prior to your first meeting with your insurance attorney. The attorney can request copies of your records from your physicians and health care providers, with your authorization; however, for the attorney to do so adds to the preparation time and the expense of your case.

4. Get copies and transcripts of any statements you have given to insurance adjusters. The familiar phrase, "Anything you say can and will be used against you," also applies in health insurance cases, particularly when statements have been given, either in writing or over the telephone, to insurance adjusters. If you have given any statements, you should write a letter to the insurance adjuster and request written copies of any and all written statements which you have given and transcripts of any and all oral statements, as well.

5. Witnesses to your health. Be prepared to provide the names, addresses and telephone numbers of important and reliable witnesses such as your medical care providers and friends, relatives or co-workers, who might provide important information about your health insurance claim.

What should I do after I have assembled my evidence?

1. Once you have assembled your materials, schedule an appointment with an attorney experienced in handling private health insurance claims.

2. Let your attorney know whether or not you work for a state or local governmental agency, or a religious entity and that your disability claim was denied or discontinued. It makes a big difference that you worked for a governmental agency or a religious entity. Your legal rights and remedies are much greater than those of people who worked for private employers.