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The True Cost of Health Insurance Claim Denials

Document with denied stamp put on the wooden table

How Denials Can Put You in the Poor House, Worsen Your Health, or Both

KFF Health News is a leading source of media coverage on healthcare policy. KFF was formerly known as Kaiser Family Foundation, but it changed its name to avoid being confused with the HMO giant Kaiser Permanente, with which it is not affiliated.

KFF has produced innumerable stories in recent years regarding the plague of crushing medical debt ruining the lives of hardworking individuals and families, seniors living on retirement income, Medi-Cal recipients, and others. These stories recount troubles caused by shockingly high medical bills that are not only unaffordable but also completely unexpected. Most often, these bills start pouring in after an ER visit or hospital stay, even for people who might have been admitted but left the facility without receiving treatment and before they were ever seen.

A single hospital visit is likely to generate a flood of bills from a multitude of departments: radiology, pathology, nursing, several different doctors and physician groups, and, of course, the hospital itself. As these bills start to crowd your mailbox while you are still recovering from an illness, injury or medical procedure, it becomes a full-time job (that no one is trained for) to sift through the pile of paperwork and figure out what insurance paid, what it didn’t and why, which providers were in network and which weren’t, which bills are going toward your deductible and which aren’t, and more. If you dispute a charge or simply don’t understand it, then you get sent down the rabbit hole of phone numbers and websites and written requests, where you are lucky to get the same answer twice if you get an answer at all.

There is no doubt that healthcare workers are a dedicated, caring, and compassionate group of people providing professional services with a commitment to your health and wellbeing. Unfortunately, this altruism gets lost somewhere along the line when it comes to medical billing. Once you are out of the hands of healthcare providers, you are in the hands of medical billing departments and eventually private debt collectors who view their job as bullying you into paying a bill you can’t afford through an endless stream of truly frightening collection letters and phone calls.

As many KFF News stories point out, crushing medical debt leaves households with a series of impossible choices: buy food or pay the hospital bill, celebrate Christmas or pay the doctor’s bill, stay home with a newborn or go right back to work because of medical bills, have a secure retirement or spend your life savings on doctor and hospital bills. It’s a bleak situation all around.

The Only Thing That Can Make Matters Worse Is When the Insurance Company Unreasonably Delays or Denies Your Claim

Everything we’ve described so far can be experienced by the uninsured as well as people with health insurance, even very good coverage. Those with high deductibles can experience the pain of medical debt to the tune of $7,000 per person or twice that per family, per year, in deductibles alone while paying over $1,200 in premiums for the privilege of being “covered.” For those with more modest deductibles (and higher monthly premiums), being told by their insurance company that their requested procedure isn’t medically necessary or that it’s an experimental treatment, or that it flat-out is not covered by the plan, can be devastating.

A denied insurance claim delivers a one-two punch to struggling households. If you’ve already had the service or procedure, you are forced to contend with unpaid bills piling up, being sent to collections, ruining your credit, and/or eating up your savings and then some. If the claim denial comes before you receive treatment, you are left to struggle with the decision of whether and how to pay for the service or forego it because it’s unaffordable. Denied or delayed medical care can have direct and immediate ill effects on your health apart from the physical and emotional strain brought on by trying to deal with the problem and find a solution.

Hope and Help Are on the Horizon to Fight and Stop Bad Faith Insurance Practices

When the insurance company makes wrongful decisions or denials, you might not only have recourse to force the insurer to cover your claim but you might additionally be entitled to a very significant monetary recovery for the harm you’ve been made to suffer because of the insurance company’s bad faith or wrongful conduct. You might even be able to hit them with a punitive damage award that says loud and clear that California public policy does not tolerate bad faith insurance practices.

Taking legal action isn’t easy; it can represent an emotional toll of its own at a time when you may be in poor physical health and struggling financially. But the silver lining is that with the help of an experienced and successful insurance law attorney, you can get the care you need, be compensated for direct financial losses as well as additional physical or emotional injuries, and hold insurance companies accountable for their wrongful conduct. Lawyers can be caring and compassionate people too, and they can lift this burden off your shoulders and pursue legal action on your behalf while you focus on healing and getting your life back in order.

If you have had a health insurance claim unreasonably delayed or denied for improper reasons, call Gianelli & Morris at 213-489-1600 for a free case evaluation. From our offices in Los Angeles, we help people throughout California ensure they are treated fairly by their insurers and take those insurance giants to task when they abuse the people they are legally obligated to serve. We welcome the opportunity to learn about your situation and find out how we can help.

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