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Alameda County Denied Insurance Claims Attorneys

Alameda County Denied Insurance Claims Attorneys

As one of the most common types of employer-provided benefits, health insurance can prevent you from paying medical expenses out of pocket. However, just because you have a policy in place does not mean your doctor’s visit or medical procedure will be covered. Like for-profit businesses, the bottom line for insurance companies is protecting their profits. One way they do this is by denying claims. At Kantor & Kantor, our team of Alameda County denied insurance claims attorneys is dedicated to helping individuals and families fight back against unethical actions by insurers.

How Common are Denied Health Insurance Claims?

The cost for even a simple procedure in your doctor’s office can be hundreds of dollars while care for more serious conditions offered through a local hospital can quickly reach five or six figures. In these cases, you may be counting on an employer-provided health insurance policy to offset at least some of these costs. When a claim is denied, it can come as a shock. Unfortunately, this is not an uncommon situation. 

According to Health Care Finance, at least 10% of all claims are initially denied, representing more than $260 million in medical costs. Common reasons for denials include: 

  • Terms of coverage issues: You may not have been eligible for coverage at the time, or the insurer may claim you failed to follow the proper procedures. 
  • Policy limits and exclusions: Even with insurance in place, there are still certain conditions and treatments which are not covered. 
  • Medical necessity: Even with covered procedures, the insurance may claim that it was not medically required. 
  • Coding errors and other administrative mistakes: A simple mistake on the part of your doctor’s office or a coding error at the hospital can result in a denied claim. 
  • Failure to get prior authorization: The terms of your policy may require you to get prior authorization before obtaining certain services. 

What to do When Your Claim is Denied

No doubt, it can be shocking to get a bill for thousands of dollars in medical treatments, which you thought were covered by your insurance plan. Rather than panicking, there are some practical steps you need to take. These include: 

  • Making a note of the reason the insurer gives for the denial. 
  • Be aware of important dates regarding responses and filing an appeal. 
  • Review all policy-related documents. 
  • Keep records of all communications you receive both from the provider and from the insurer involved. 

The Employee Retirement Income Security Act of 1974 (ERISA) governs employer-provided benefits and can help to protect your rights when dealing with a denied claim. Speak with an experienced ERISA attorney right away to discuss your options.

Contact Our Office Today to Discuss Your Denied Insurance Claim

At Kantor & Kantor, our Alameda County denied insurance claims attorneys are strong advocates for those facing insurance claims appeals. Our experienced lawyers can work to protect your rights and guide you in appealing denied insurance claims. Contact our office to request a consultation today.

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