When you purchase a health insurance policy, what are your expectations as you pay the hefty premium amount each and every month? Do you believe you are entitled to the medical treatment that is in fact covered under your plan? In the event you fall victim to an illness, wouldn't you assume that your insurance plan covers the required treatment in order for you to become well again? Unfortunately, denied insurance claims attorneys in Detroit, Michigan inform you that many insurance carriers deny claims left and right, whether they are acting out of bad faith or simply rejecting your claim identifying it as â€œmedically unnecessary.â€
Generally, when an individual receives a denial letter stating their insurance company is no longer able to cover their medical visits or the medication they have been prescribed, a policy holder has the right to file for an internal review. Upon determination, if the insurer continues to deny the claim and the consumer believes they are in fact entitled to receive these benefits, an external review can be conducted where an outside source reviews the claim and its entirety to determine whether they should in fact receive the benefits in order for them to regain wellness.
Although insurance carriers are expected to carry out these reviews as some patients suffer from serious, life-threatening illness, and do in fact require the treatment or medication they are fighting for, not always is this process carried out properly. Insurance claim dispute lawyers in Detroit highlight a recent case that has developed in the state of Michigan involving a patient who is suffers from Hepatitis C. According to the State of Michigan Department of Insurance and Financial Services, they determined the individual who filed a complaint may in fact have done so with legitimate evidence.
Apparently, the woman involved in the case was prescribed the drug Harvoni which is used to treat cases of Hepatitis C. Her insurer came back stating it wasn't medically necessary and that she didn't reach the degree of severity in order for her to obtain the drug with their coverage. Her physician, who appeared to be quite concerned regarding her condition, wrote a letter providing all the medical evidence that proved she did in fact need the medication in order for her condition to stabilize, and not worsen.
An investigation is underway to determine whether or not the insurance company, identified as Health Alliance Plan, acted out of bad faith, failed to carry out their required duties, or was in fact right for submitting their denial notice to the patient.
If you are ever faced with a denial notice from your insurer and they fail to provide you with the adequate coverage, you are urged to seek legal aid from a reputable denied insurance benefits attorney through Christopher Trainor & Associates. This insurance claim dispute law firm is conveniently located in Michigan, and offers you a free case evaluation. You could be well on your way to obtaining the rightful benefits you had expected to receive with their expertise and assistance.