Over the years, California and its residents have developed a reputation for fighting for more expanded health care. It surprises no one, then, that its residents would attempt to go up against big insurance companies to achieve this. What might surprise the nation is the fact that they won.
CNN shares that, in 2019, California residents won a $91 million case against the country’s largest insurance company for wrongful denials. The case played out in courts for 10 years and involved an alleged 900,000 bad faith claims. Thankfully, patients do not always need to go to court to resolve insurance denials.
The Los Angeles Times recommends that patients collect all relevant documentation they may have. This may include prescriptions, medical records, recovery plans and communications with health care providers.
Sometimes, the health care provider may serve as an ally. The team may reach out to the insurance company and continue to fight for patients to have medical procedures covered. Some patients also saw results when the medical doctor submitted a letter or placed a call.
Patients may only have 180 days to appeal denials. After filing the appeal, the insurer may then have 30 days to respond or resolve the issue. In more urgent situations, patients may get a much faster response.
Seek government assistance
California residents may have plans regulated by government agencies. When this happens, residents may seek free reviews from the responsible agencies after a denial or if the insurer does not respond within the prescribed deadline.
The more claims insurance companies deny, the more money they pocket. Unfortunately, many will risk lives to use this method of padding profits.