Oklahoma City Health Insurance Bad Faith Attorneys
Health Insurance Disputes & Bad Faith Claims in Oklahoma
Health insurance is one of the most complicated, tedious areas of insurance to understand and navigate. Moreover, a denial of your health insurance claim can threaten your financial security and affect your ability to access medical care.
If your health insurance claim has been denied, the first thing to do is to identify the insurer’s reason for denying your claim. The insurer, your doctor, or the hospital may be able to help explain the insurer’s stated reasons for refusing coverage. The reasoning behind a denial will provide some insight as to your options.
Next, you should consider reaching out to an attorney if you believe that your health insurance provider has wrongfully denied your claim. At Fulmer Sill, our Oklahoma City health insurance bad faith attorneys handle all types of health insurance claim disputes, including claim denials.
Why Do Health Insurance Providers Deny Claims?
There are many reasons health insurance companies may dispute or deny claims, some valid and others not. Understanding why your claim was denied is an important first step in resolving the matter.
Common health insurance claim denials include:
- Denial of services or procedures not covered by your policy
- Denial because a procedure is considered experimental, cosmetic, investigational, or not medically necessary
- Denial because a referral or pre-authorization was required
- Denial because you used an out-of-network provider
- Denial for typographical errors
- Denial for timeliness
- Denial due to policy limitations
Many of these reasons for denial can be addressed, either by appealing the insurer’s decision or by contacting the doctor or hospital to make corrections to the documents submitted.
When an insurer refuses to pay a claim, you may respond or appeal in the form of a letter that includes your best arguments against the decision and any supporting evidence or documentation. This appeal should focus on the specific grounds for denial that were listed in the notice of denial provided to you by the insurer. Where an appeal is unsuccessful, and the insurer refuses to accept your valid claim, you may need to sue them for their claim denial.
Can You Sue a Health Insurance Company for Refusing to Pay Your Claim?
Although many health insurance claim disputes can be resolved without filing a lawsuit, it may become necessary to take legal action in certain cases. If you believe your health insurance provider is acting in bad faith, but the company has refused to accept your valid claim despite an appeal, you may need to file a lawsuit against your health insurance provider.
Generally speaking, you may sue your health insurance company if it violates any of your rights or protections under the specific policy. Such conduct is referred to as “acting in bad faith” and serves as grounds for a lawsuit.
Examples of health insurance bad faith practices include:
- Unnecessarily delaying the approval or denial of a claim
- Failing to promptly and/or properly investigate a claim
- Wrongfully claiming lack of coverage
- Refusing to pay a valid claim
- Making threatening statements
- Refusing to provide reasonable documentation
- Denying a claim without providing a sufficient reason
- Delaying or denying claims involving requests for medical treatment approval
- Misrepresenting policy-related matters, including coverage
- Unnecessarily delaying payment of a valid claim
If you believe your health insurance company has acted in bad faith, reach out to our team at Fulmer Sill right away. Our Oklahoma City bad faith health insurance attorneys can help you fight back against your provider’s wrongful conduct and seek the fair payment you are owed.
Cancer Health Insurance Claims
Cancer insurance policies provide supplemental benefits and are designed to pay cash benefits that offset the significant costs of cancer treatment and rehabilitation. Health insurance is a great help, but numerous expenses may not be covered, such as out-of-network treatments, home health care needs, and experimental treatments. Cancer insurance policies help cover additional medical expenses and indirect, non-medical expenses related to cancer that most medical plans don’t cover.
Many insurance companies try to cut corners by denying or underpaying these insurance claims. At Fulmer Sill, our attorneys know how this type of coverage works and, more importantly, know how insurance companies work to increase profits by denying or minimizing the amounts paid on these claims. If your health insurance company is disputing or has denied your cancer insurance claim, reach out to our team right away to learn how we can help.
If an insurance company has denied your claim or has not paid you what is owed under the explicit terms of the policy, it may have been acting in bad faith during the handling of your claim. Our Oklahoma City health insurance attorneys handle all types of insurance lawsuits where an insurance company has acted in bad faith towards its insured during the handling of the claim. This includes not only denied claims or underpaid claims but also claims where there are delayed payments and only partial payments made by the insurance company.
At Fulmer Sill, we genuinely care about the individuals and families we serve. By limiting the number of cases we accept, we are able to provide every client with a high level of personal attention, communication, and guidance. Our attorneys utilize a collaborative approach, combining their unique experience and skillsets with the full resources of the firm. This allows us to handle claims efficiently while providing our clients with high-quality legal service from start to finish.
You can rely on our tenacious and hardworking team to fight tirelessly for every penny you are owed.