Health insurance claim denials can be exceedingly difficult to handle from both a financial and emotional perspective. In health insurance claim disputes, not only are you saddled with the unique challenge of having to recover from your injury or illness, but depending on the circumstances (e.g., if your insurance provider makes a significantly undervalued offer or denies your claim entirely), you could be left with significant bills. Whether your health insurance provider chooses to cover your treatment could spell the difference between bankruptcy and solvency – and in many cases the difference between prompt treatment that can save a patient’s life and an unknown future. The stakes in health insurance disputes are often rather high. If your insurer acts in bad faith, you may therefore be entitled to recover damages for emotional distress, among various other losses.
As a general rule, insurers are incentivized to avoid or minimize their potential liabilities, even when a policyholder clearly qualifies for benefits under their coverage contract. By ramping up the administrative cost for the policyholder, insurers can effectively reduce their benefits liabilities and undermine the ability of policyholders to challenge the legitimacy of their actions.
Successful insurance litigation requires client-oriented legal representation from beginning-to-end of the process. At Berg Plummer Johnson & Raval, LLP, our Houston insurance coverage and litigation attorneys have decades of combined experience representing policyholders against their insurers for wrongful denial, delay, missed payments, underpayment, and other issues entitling the claimant to challenge the decision of the insurer.
We Fight for Texas Healthcare Policyholders to Get the Compensation They Deserve
When it comes to health insurance, an injured policyholder who requires significant medical treatment may find themselves in a situation where they are held hostage to the whims of their insurer. If an insurer denies your claim, underpays your claim, or delays payment, you could be left in financial limbo with no means with which to pay your medical bills. An experienced Houston health insurance lawyer can help you recover the compensation you deserve.
Berg Plummer Johnson & Raval, LLP is committed to helping policyholders obtain their rightful benefits. We represent clients in Houston and throughout Texas who were wrongfully denied a health insurance claim or whose claims were unjustly delayed.
Why Hire a Houston Health Insurance Lawyer?
Though one may believe that their claims are covered by their insurance policy, the insurer benefits a great deal from interfering with the payout. For example, if an insurer wrongfully denies a health insurance claim, and the policyholder decides not to challenge the denial (and potentially recovering damages), then the insurer will effectively avoid a payout that they otherwise would have had to honor.
As health insurance providers are naturally in conflict with their policyholders, it is critical that policyholders take an active role in making sure their claims are fairly considered and processed by their insurance providers. If the insurer fails to act in accordance with their duties under the law, you should connect with an experienced Houston health insurance lawyer who can counsel you through the process of obtaining a favorable resolution.
Common Reasons for Insurance Claim Delays or Denial
Difficulties in having an insurance claim processed and accepted can be related to, but are not necessarily limited, to:
- Category of treatment not covered (e.g., mental health issues not being covered by the existing healthcare plan)
- Treatment considered “not medically necessary”
- Denial on the basis of incomplete evidence
- Administrative and clerical errors
- Delayed submissions
- Valuation of costs does not accurately reflect claim
Pre-Authorization Issues? We Can Help.
In some health insurance disputes, the policyholder may have failed to obtain pre-authorization from the insurer before receiving treatment. Failure to obtain pre-authorization may result in a claim denial, but the denial will not necessarily “stick.” If you can demonstrate that the treatment was necessary and would have been authorized by the insurer, then you may be able to successfully challenge the denial.
If you have had your health insurance claims wrongfully denied, delayed, undervalued, or otherwise interfered with by the insurer, it’s important that you connect to a qualified health insurance attorney with a track record of success in challenging the decisions of insurance providers and obtaining favorable results. Depending on the terms of the coverage, your attorney may have to re-file your claim, challenge the denial through an internal administrative process, and eventually file a lawsuit in court and take your case to trial.
Proton Beam Therapy Insurance Denials
One very specialized area of health insurance claim denials involves the denial of proton beam therapy treatment for cancer at MD Anderson Cancer Center and other Texas cancer treatment facilities.
What Is Proton Beam Therapy?
Proton beam therapy is a type of radiation treatment used to treat cancer patients, often recommended for difficult tumors. This cancer treatment has advanced and become popular in recent years. Proton beam therapy is as effective as Intensity Modulated Radiation Therapy (IMRT) at killing cancer cells, but it delivers radiation in a more precise way that has far less damaging side effects than conventional radiation treatments. Proton beam therapy can radiate only the cancerous tumor while avoiding radiating (and potentially seriously harming) healthy parts of the body.
While one would hope proton beam therapy would be used more often to treat cancers, as it has been in use for decades, health insurance companies all too often deny coverage for this important cancer treatment. Even worse, the insurance industry often employs unqualified, biased medical personnel to make these critical claim decisions. We have successfully resolved proton beam therapy insurance claim disputes and welcome the opportunity to discuss yours with you and your loved ones.
Contact a Houston Health Insurance Claim Lawyer
Struggling with an insurance claim issue in Texas? We can help you fight for your rightful benefits. At Berg Plummer Johnson & Raval, LLP, our attorneys have decades of experience helping clients litigate health insurance coverage issues and obtain the benefits they deserve. Our law firm is committed to providing best-in-class legal representation that is considerate of our clients’ varying financial limitations and strategic needs. To that end, we aim to provide our clients with their choice of fee arrangements that are customized to their particular needs. We will work with you to develop a customized strategic roadmap and budget that helps you accomplish your legal objectives without excessive spending. Call (713) 526-0200 or fill out our online form for more information.