Fighting Insurance Claim Denials for Sanitation Workers and Waste Management Employees
Insurance companies deny claims from public and private employees alike. If this has happened to you and the insurance company has broken the law, the experienced Orange County health insurance claim denial attorneys at Quincey Law can stand up for your legal rights.
Insurance companies have a financial incentive to delay or deny your claim. They know that many claimants will simply go away or do not have faith in the appeals process. What many do not know is that the insurance company does not always get the final word, and they can even be punished by a court or jury if they have broken the law.
Do not let the insurance company get away with illegal conduct that has resulted in the denial of your claim. Schedule a free initial consultation with an Orange County health insurance claim denial attorney at Quincey Law who can help you get the care you need and take action against the insurance company. Call our team at (866) 945-9175.
Insurance Companies Can Use Questionable Tactics to Deal with Sanitation Worker Claims
Sanitation workers are offered health insurance through their job. These workers are often unionized, and the union negotiates health insurance coverage with the employer. Sanitation workers and waste management employees are able to choose their own health insurance company from a list of options, just like any other worker.
A health insurance company may challenge a claim on the ground that it lacks medical necessity. That determination may not even come after a conversation with your treating physician. Even if they have approved an initial claim, the health insurance company may refuse to pay for subsequent care or procedures. You may be stuck in a never-ending battle to get the care that you need and to which you are entitled under the terms of your policy.
Your Health Insurance Company Must Act in Good Faith
California law gives you the ability to fight back when the health insurance company has wrongfully denied your claim. Health insurance companies have a general duty to act in good faith, and they have specific duties under California law to avoid acting in bad faith. Examples of bad faith include the following:
- Refusing to cover a valid claim
- Denying a claim without adequate investigation
- Refusing to consider all of the evidence that shows medical necessity, relying only on their own opinions
- Delaying consideration of a health insurance claim to pressure the claimant into accepting a lesser amount of care or giving up on their claim entirely
- Approving only part of a treatment plan, or reimbursing a claim in such a low amount that the patient is left with high out-of-pocket costs
All of these are realistic scenarios, and they are things that sanitation workers may have had to endure when dealing with health insurance companies. The good news is that California law allows you to fight back.
What to Do When Your Health Insurance Claim Has Been Wrongfully Denied
Before you do anything else, you must understand the exact reason why your claim was denied. The health insurance company is required to give you an explanation for why they are not paying for your coverage. You have the option of going through the internal appeals process that the insurance company offers. Although the likely result is that the insurance company will not reverse itself, you may desire to go through the internal appeals process to persuade a court that you did everything in your power to resolve the dispute. You can also obtain an external review through the California Department of Managed Care, which can result in overturning the denial.
Since ERISA does not apply to your claim because you are a public employee, you have far more options and leverage when it comes to dealing with the insurance company. After you have gone through the internal appeals process, which you may choose to exhaust first (although there is no strict requirement to do so), you can file a lawsuit directly against the insurance company in court. Not only do you have the possibility of forcing them to pay your claim, but you may even be able to obtain damages directly from the insurance company if you are able to prove that they acted in bad faith.
Contact an Orange County Health Insurance Denial Law Firm
At Quincey Law, we understand your need for critical health care, and we will not tolerate the insurance company wrongfully denying it. Take the first step towards fighting back by speaking with an Orange County Health Insurance claim denial lawyer. We offer free initial consultations, and you can schedule one by messaging us online or by calling us today at (866) 945-9175.