How to get my home health care insurance company to settle what I believe is a legitimate claim or at least explain its denial?
Walla Walla, WA
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Posted about 1 month ago in Insurance
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As a policy holder, I believe that upon outlining my projected course of action I was entitled know if the expenses involved were covered by the policy. Instead, I had to actually incur the expenses and submit them to see what would happen. In a following submission, the personel involved apparently decided that the prior policy interpitation was incorrect and that a different one would be made on a retroactive basis. Moreover, my many attempts to engage in a meaningful dialogue or obtain an explanation, for the denial of what I believe to be a legitimate claim have failed. It is my belief that an impartial jury would conclude that after deducting the partial compensation already received, I am entitled to a refund of my premiums, and probably punitive damages as well.
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Answers (1)Jeffrey Edward Burkhart
This attorney is licensed in Washington.
Posted about 1 month ago.
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The basic answer is, as usual, "It depends on what the policy says." Unfortunately, policies are often written in complicated language that is hard to understand, so it's not always easy to get an answer. The bottom line is typically a determination of what is "medically necessary."
As for the denial of claim, most likely your avenue is file an appeal. Careful, because most insurance companies require that the appeal be filed within thirty days of the denial. You can write the appeal yourself, or hire a lawyer do it for you. Disclaimer: This answer does not create an attorney-client relationship. You must not rely on it for legal advice. The answer might be different if more facts and details were known. Procedures and standards vary for each individual case. |