Hospitals and other healthcare providers often work directly with your health insurance company to submit a claim for payment. Many policyholders do not fully understand their financial responsibility under a policy.
Health insurers may deny claims, in whole or in part, for a number of reasons, including: the treatment was not “medically necessary” or was “cosmetic”; you did not obtain pre-authorization for the treatment; the insurer required additional information to process your claim; or the treatment was administered by an “out of network” provider.
You may receive an Explanation of Benefits (“EOB”) or other document stating that the health insurer is refusing to pay for some or all of your medical expenses. If you believe the health insurance company has denied your claim in error or required you to pay more than your share under the policy, contact the attorneys at MGW to schedule a free consultation.