Inland Empire Health Insurance Claim Denial Attorney – Serving California
Health insurance companies do not have an unfettered right to deny claims and respond to you on their own timetable. Quincey Law can help you enforce your own legal rights when payment of your health insurance claim has been wrongfully denied or delayed.
Attorney Nicholas Quincey at Quincey Law knows how to get results for clients and cut through red tape when the health insurance company will not pay your claim in the manner or time you expected. A San Bernardino & Riverside health insurance claim denial attorney at Quincey Law can help you take strong legal action to get the coverage that you deserve under the terms of your policy.
Quincey Law is located at 9302 Pittsburgh Ave 230 Rancho Cucamonga, CA 91730. Our office is located not far from the intersection of Milliken Ave and 6th Street. Call us at 909-330-3523 to schedule a free initial consultation.
Our law firm is known for the work we do on behalf of our clients. When we need to litigate, the gloves come off in a hurry.
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“Nick fights hard for his clients. Guided by a strong moral compass, he provides fair and honest insight as to what is in your best interest. He is incredibly diligent, and a straight shooter. You feel like he is always in the trenches with you, and guiding you through tough times. I am so grateful to have worked with him on matters over the last few years. I cannot recommend him highly enough.”
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Health Insurance Companies Often Deny Claims
You never expect to receive a denial of your claim from your health insurance company. You are likely thinking that you have paid for your policy, and your insurance company should be there when you need them. Unfortunately, that is not always the case. Your claim could be denied entirely, or the insurance company could unreasonably delay the process.
Why Health Insurance Companies Will Not Pay You
Your doctor recommends medical care for the sole reason that you need it, and it is beneficial for your health. However, health insurance companies may deny benefits for a number of alleged reasons, including:
- The care is not medically necessary, no matter what your treating physician says
- The care is investigatory or experimental (which is a reason that insurance companies give for denying many cancer treatment claims)
- The treatment is not covered by the terms of your policy
- Your medical care was not approved ahead of time
- There were errors in the claim (presumably, these mistakes can be fixed, and the claim should be covered)
- You have not tried a potentially effective yet less costly avenue of care first
In reality, health insurance companies may refuse coverage because the care simply costs too much money and harms their own bottom line. Regardless of why a health insurance company refuses to cover your medical care. You always have the right to fight back, and you can seek internal and external review of their claim denial.
Handling Health Insurance Denials Involving:
California Health Insurance Company Requirements
Health insurance companies are tightly regulated under California law. There are a myriad of requirements that they must follow in processing and responding to your claim (or in selling you a health insurance policy), including:
- Responding “reasonably promptly” to your communications
- Not making any misrepresentations about the policy benefits
- Not unreasonably delaying the processing of your claim
- Conducting an adequate investigation and review before they make a determination about your claim
- Promptly paying health insurance providers when the insurance company has been billed
Insurance companies can be held accountable when they violate these regulations and you may be able to sue the health insurance company.
The Process for Appealing a Health Insurance Claim Denial in California
If your health insurance claim is denied, you should go through health insurance company’s internal appeals process before you take your case to court. If you can make a compelling case at the outset, you may be able to prevail without having to file a lawsuit. However, health insurance company appeals processes may not always give you a fair shake, and you may still end up without the coverage you need and expect.
If your insurance company persists in denying your claim, you can take your case to court. A judge or jury could review your policy and the facts of your case before they make the final determination of whether the insurance company must pay.
Bad Faith Lawsuits Against California Health Insurance Companies
Forcing the insurance company to pay for your coverage may be just part of what you can do when they have denied a claim. Depending on the circumstances behind the denial, you may be able to file a lawsuit directly against the insurance company. Every party to a contract has an implied duty to act in good faith, and they can be liable to you for breaching that duty.
If you had a valid claim, and the insurance company refused to pay, they may be liable to pay you damages for the harm their unreasonable denial caused you. Insurance companies fear bad faith lawsuits, which may give you some leverage in dealing with them.
Contact an Inland Empire Health Insurance Claims Denial Law Firm Today
Quincey Law handles health insurance claims denial lawsuits throughout the state of California, including in the Inland Empire, San Bernardino, Victorville, Ontario, Riverside, Moreno Valley and Corona from our office in Rancho Cucamonga. Call 909-330-3523 or fill out our confidential contact form to speak to someone at our office. Together, we can seek justice.