Sometimes, when we want to claim our health insurance, the insurance company denies the claim. You might not know how to deal with this problem and think about hiring a lawyer to fix this. But not every insurance problem can be fixed by lawyers. You should know the right time to hire lawyers for health insurance claims.
Before you hire a lawyer for your insurance problem, you should know about health insurance claims denied. Let’s check the explanation below!
Why Did Health Insurance Claim Got Denied?
Before discussing the right time to hire lawyers for health insurance claims, you should know why the insurance company denied your claim.
1. Information That Needs to be Updated or Updated
Make sure to update the information again if you experience a change of address, change of job, and other vital data. If a claim is filed late, it will most likely be rejected.
It is important to submit claims on time because most insurance companies have a time lag in which they can accept claims. If we go through that time too long, be reassured if the claim is rejected.
2. Health Insurance Claims Do Not Comply with The Policy Requirements
Each health insurance policy has terms that vary, depending on the related insurance product policy. For example, critical illness insurance generally stipulates survival and waiting periods.
These two are essential for you to pay attention to because they will affect whether or not an insurance claim can be made. The survival period is during the insured survives from the diagnosis of a critical illness to death.
Generally, the survival period requirements are 14 days, 30 days, and some 7 days. A waiting period is required for the insurance policy to take effect. Not all insurance stipulates this requirement, but if there is, you should pay attention to it too.
Because if a claim is submitted when the waiting period has yet to be fulfilled, your claim submission will automatically be canceled.
3. Services are Not Covered by Insurance
It is essential to understand the services covered by insurance from the start. In an insurance policy, it will be explicitly stated what the scope of protection is provided. Feel free to ask about this policy in more detail at the insurance provider because this will prevent us from doing things that are not desirable.
For example, for a life insurance policy, the protection will be void if the insured dies by suicide. That way, the filing of the claim will also be rejected by the insurance company.
4. Incomplete Claim Documents
Before you call lawyers for health insurance claims denial, you should check again to your document. In each claim submission, the insurance provider asks you to fulfill several supporting documents according to the policy’s provisions.
Pay attention to what the insurer requires documents for processing claims. The more complete the documents you submit, the smoother and easier the claim process will be.
5. Payment of Insurance Premiums is Overdue
The claim will be rejected when submitted if your insurance premium payment is due. Each insurance has a different grace period, generally up to 45 days. There is also a grace period between 30-60 days. So, it is essential to pay insurance premiums on time.
6. Hiding Important Information
Another thing that can also be a decisive reason for refusing an insurance claim is when the insurer finds that the policyholder deliberately withheld crucial information at the start of purchasing the policy.
For example, someone buys life insurance. In terms of purchasing a policy, namely, when filling out a Life Insurance Application, the insurer has asked the customer’s good faith to disclose the health information of the insured as clearly as possible.
Do We Need Lawyers for Health Insurance Claims Denial?
In some health insurance matters, the policyholder may fail to obtain pre-authorization from the insurance company before receiving treatment. Failure to obtain a pre-authorization may result in denying the claim, but such a disclaimer does not necessarily “stick.”
If you show that treatment is necessary and will be authorized by the insurance company, you may successfully resolve the refusal. Not all insurance problems always require a lawyer. Some lawyers specialize in insurance claim denials, but like all lawyers, they cost money.
If you are going to lose your home if you have to pay this bill, it’s worth a one-hour legal consultation to see how they can help; if it’s a few hundred dollars in lab fees, it isn’t.
However, if you are not familiar with insurance claim denials or you are simply too busy to deal with rejected insurance claims, then you must connect with qualified lawyers for health insurance with a track record of success challenging insurance providers’ decisions and reaping the benefits.
Depending on the coverage terms, your attorney may re-submit your claim, challenge the objection through an internal administrative process, and finally file a lawsuit and take your case to court.
How To Deal with Health Insurance Denied?
If you don’t want to hire lawyers for health insurance claims, you can deal with health insurance being denied. Here are things you can do.
- Double-check the details of personal information submitted when you first made the policy, whether anything was missed or not by the facts.
- Underline the words stating protection (implied and expressed) for further consultation with the insurer.
- Understand the exclusions in your insurance policy, such as pre-existing conditions, death due to participating in a crime or suicide, intentional or engineered accidents, and many others.
- Complete the documents needed when submitting a claim, including filling out the provided claim form, including the minutes of the chronology of the loss (can also be directly in the form of a hospital bill), original insurance policy, and others depending on the individual needs of each customer.
- Pay attention to the expiration date of claims, where the average claim filing time ranges from 30-60 days.
- Routinely pay premiums so as not to experience lapsed (inactive policy) due to arrears that trigger a grace period or even the policy’s expiration
Ready To Fight For Health Insurance Claim?
That’s all about why you need lawyers for health insurance claims denial. If you want to fight the denial of health insurance claims by yourself, you can do it yourself. So, you must consider why your claim gets denied and how to deal with it.