Recent Blog Posts
Can You Appeal an Unfavorable Decision From the Health Insurance Marketplace®?
According to the Centers for Medicare and Medicaid Services, over 8.2 million people chose a plan during the recent open enrollment period for participation in the Health Insurance Marketplace established under the Affordable Care Act. Out of those numbers, approximately 1.8 million enrollees were new to the marketplace, with about 6.4 million people renewing their coverage in Obamacare.
Is Plastic Surgery Covered by Medicare?
Cosmetic surgery isn’t all about vanity or keeping up with the Kardashians. For many people, improving their looks is critical to their emotional and mental health and well-being, especially when they are living with what most people would consider a physical defect as opposed to wanting a facelift to look younger or a nose job to appear more attractive.
Fighting Insurance Claim Denials: Will an Attorney’s Contingency Fee Eat Into My Benefits?
You need to fight that denial, and you are probably going to want to hire an experienced insurance law attorney to represent you.
Learn more about how the contingency fee can be beneficial to ensure you get the legal rep you need for your case.
Is Your Insurance Company Stalling on Your Health Insurance Claim? Here’s What to Do.
When you need coverage for a medical issue, you might not have time to wait, and any delay might seem unreasonable.
If you think your insurer is taking too long to come around, here are some things you can do to assert your rights.
My Insurer Won’t Return My Calls. Does That Mean They Are Not Working on My Case?
Your health insurer is responsible for communicating with you about your case on a regular basis. If your claims adjuster is ignoring your calls, they could be engaging in bad faith conduct geared toward getting you to drop your claim or accept a lowball settlement.
Learn about the applicable laws in your state, and don’t be afraid to assert your legal rights and hold your insurance company to any applicable timelines.
Why Did My Claim for Long-Term Disability Benefits Get Turned Down?
We’ve talked about long-term disability insurance (LTDI) as an excellent tool for doctors and other professionals to guard against income loss in the event of an injury, illness or other disabling condition. We’ve talked about the need for LTDI and the different types of policies one can purchase. One aspect of LTDI we haven’t touched on yet is the possibility that you’ll purchase a policy (through your employer or on your own) and pay your premiums diligently over the years, only to have your benefits turned down when you actually need them. Today, we explore the different reasons insurance companies give for rejecting LTDI claims and what you can do if you think your application for benefits was wrongfully denied.
Long-Term Disability Insurance for Doctors
Last month we talked about long-term disability insurance (LTDI) for professionals in general and medical doctors in particular. That article discussed the different types of LTDI policies (“own occupation” versus “any occupation”) and covered some of the reasons you might want to have LTDI coverage.
Who Needs Long-Term Disability Insurance?
Long-term disability insurance (LTDI) provides replacement income for policyholders who become unable to work because of an illness or injury. In theory, any worker could benefit from LTDI, but these policies are most often held by company executives and professionals who specialize in a particular field and cannot easily transition to another line of work should they become disabled from performing their specific job. For this reason, LTDI is especially attractive to doctors in general and specialists such as surgeons in particular.
Is Artificial Disc Replacement “Experimental and Investigational”?
If you ever see the phrase “experimental and investigational,” it’s likely to be in the context of a letter from the insurance company refusing to cover your requested surgery or other medical procedure. “Experimental and investigational” is a favorite phrase of the insurance industry. Carriers create internal memos, called Policy Bulletins, that label a particular procedure or medical device as experimental and investigational, and then they rely on that memo to issue blanket denials of all requests for the treatment, without conducting an individualized assessment of the patient’s condition and whether the requested procedure might be appropriate. These blanket denials could be seen as an abdication of the insurer’s duty to investigate each claim individually and make a decision based on the specific facts of the case. Denials like these might even be considered insurance bad faith. Additionally, lawyers who represent patients have found that insurance companies label some treatments as “experimental and investigational” despite abundant evidence demonstrating the procedure is neither experimental nor investigational. Artificial disc replacement is one such example.
What You Need to Know About Independent Medical Review
In a previous post, we talked about using an insurance company’s internal appeals/review process if the insurer denies your claim or request for treatment when you think they should have approved it (see Why an Internal Appeal is a Really Big Deal). There, we noted how a federal law (ERISA) that governs employer-sponsored health plans requires that insurers have such a procedure in place and further requires policyholders to use that procedure before they can file a lawsuit. We also noted how important those appeals are because if you later go to court, the arguments you want to make or evidence you intend to give can be limited by the record you created at the administrative level.