When Insurers Say ‘Not Medically Necessary’ for Post-Op Care
Your need for medical care after a surgical procedure does not always mean that the insurance company will cover it. If your post-op medical care has been denied, an experienced Orange County insurance bad faith attorney at Quincey Law can help.
You cannot and should not simply accept it when the insurance company denies care that you need after a surgery. Not only do you have the potential to force the insurance company to cover the care, but you can also take legal action directly against the insurance company under certain circumstances. You can get not only the care that you need, but you may be able to obtain compensation from the insurance company.
The first step in the process of fighting back against the insurance company comes when you speak to an Orange County Insurance bad faith lawyer at Quincey Law. We are passionate about holding these large businesses accountable and getting Justice on your behalf.
The surgery itself is just the beginning of the care that you need to make the fullest possible recovery. Post-op care starts in the hospital or surgery center immediately after the procedure. Then, it may include rehabilitation or follow-up procedures to improve your health. If you do not get the necessary post-op care, you could be in immediate danger due to complications, or you may not make a robust recovery.
Each aspect of your care is subject to approval from the insurance company, which must pay the claim. If the insurance company fails to approve the necessary post-op care, your short and long-term health can be endangered.
What to Do When Your Post-Op Care Is Denied
You have a pressing need to ensure that you get the care that you need after a medical procedure. Your first efforts should be aimed at doing what is in your power to force the insurance company to cover your care. However, insurance companies may not listen to you as an individual because they do not fear your capability to fight back. Accordingly, if your post-op care has been denied as not medically necessary, you should do the following:
- Review the documentation provided by the insurance company, with the reason given for the denial
- Maintain copies of all communications with the insurance company
- Consider appealing the denial of your care through the internal process available to you
- Contact an insurance claims denial lawyer to learn whether you can fight the decision and potentially take direct action against the insurance company
Given the criticality of post-op care, it is essential that you take action immediately. Days matter when it comes to your health after you have undergone a major procedure. You cannot afford to wait indefinitely for the care that you need.
Getting Accountability from the Insurance Company
You may hold an insurance company accountable for denied post-op care in several respects. You can always seek a review of any decision denying your post-op care. The problem is that your health hangs in the balance, and you may lose valuable treatment time while you are fighting with the insurance company to cover your care. Nevertheless, if you so choose, you may go through the internal appeals process before you seek external review of any care denial.
In rare instances, you may even be able to sue an insurance company if you were injured by having your care denied. For example, if your condition worsened because you had care wrongfully denied by the insurance company, you may hold them accountable. You must show a direct link between the denial and your injury. Of course, you must also show that the denial itself was wrongful.
You may take action directly against the insurance company if they have acted in bad faith. The insurance company must have a valid reason why they have denied your case. Their claims of lack of medical necessity cannot be specious or a thinly veiled attempt to save themselves money at the expense of your health. If the insurance company has denied a claim without adequate medical investigation, or they have refused to pay for care that is clearly covered by your policy, you may even file a bad faith lawsuit. Then, you can seek damages directly from the insurance company. If you win your lawsuit, you may even be awarded punitive damages.
Contact an Orange County Insurance Bad Faith Law Firm
When you need to take strong legal action against an insurance company because they have broken the law, an Orange County Insurance bad faith attorney at Quincey Law can lead the fight. Call us today at 866-945-9175 or fill out an online contact form
Nicholas Quincey is the founder of Quincey Law, and has over a decade of experience of handling insurance claims denials and personal injury matters for people throughout California. We have pursued insurance bad faith claims for people involving life insurance, health insurance, homeowners and disability insurance. We also work with clients and families who need assistance filing and pursuing a personal injury matter. Learn more here.