Don’t Let Your Insurer Deny Coverage For Necessary Treatment
Last updated on May 13, 2025
Health insurance claims can be some of the most frustrating to deal with. For many, they are unnecessarily complicated, and insurers often deny necessary or even lifesaving coverage to protect their bottom line. If you are dealing with a denied health insurance claim, you may wonder if your health insurance provider did so out of bad faith. If you believe they did, you may be able to seek compensation, justice and accountability with help from our lawyers at MGW Law. Our team has 50 years of combined experience in the insurance industry and knows how to effectively pursue the coverage you need on your behalf.
Bad Faith Tactics Used By Health Insurers
There are several ways health insurers act in bad faith. A few examples include:
- Conducting biased medical reviews
- Delaying the prior authorization process for approving medical treatment
- Misrepresenting key provisions of a person’s health insurance policy
- Ignoring policyholders’ questions and concerns
- Asking for unreasonable evidence
- Failing to investigate a claim thoroughly
We are not afraid to challenge your health insurance provider to get you the medical coverage you need. Call 920-383-3911 to learn more about what we can do for you.
How We Can Help With Bad Faith Health Insurance Practices
Here are a few examples of what we can assist you with:
Medical Necessity Denials
Even when your physician encourages you to seek a specific type of treatment, the insurance company may still deny you coverage. To do so, they may use tactics like utilizing a biased second opinion, shifting requirements and manipulating internal reviews. We can help challenge these tactics and fight to have the insurance company recognize and uphold your doctor’s expertise and recommendations.
Preauthorization And Retrospective Denials
Insurers may approve treatments only to deny them retroactively. These tactics can make handling emergencies more daunting and uncertain. We’re ready and equipped to confront insurers about any unreasonable delays or shifts in coverage that come up at the last minute. You should be able to expect to get the coverage you pay for without surprises, and we’ll do everything we can to hold your health insurance provider accountable. You deserve to get the treatment you need when you need it.
Out-Of-Network Coverage Issues
Out-of-network coverage issues can lead to a host of problems such as billing disputes and a lack of transparency over provider network status. Our team understands the importance of network adequacy, and we will fight to make sure you have access to the services you need.
Experimental Treatment Exclusions
Insurers may try to classify established treatments as experimental. Many ignore peer-reviewed evidence and FDA approvals to deny you coverage. We aim to rectify these exclusions and fight to get your legitimate medical treatment covered by your insurer.
Prescription Drug Coverage
Insurers sometimes use formulary exclusions to avoid paying for certain prescription drugs. In many cases, these actions may be in bad faith. We can help you address prior authorization abuses and specialty drug denials by your health insurance provider to fight for your needed medications tenaciously.
Chronic Condition Treatment Denials
Some insurers may put arbitrary coverage limitations into your policy to avoid covering treatments for chronic conditions. These policy limitations can disrupt the coverage you need to afford your treatment. We can challenge these arbitrary caps and premature discharge practices. We can also advocate for mental health parity and coordinated long-term care. We aim to ensure you have the appropriate coverage and compensation for the level of care your condition requires.
Benefits Coordination Problems
Benefit coordination issues often result in improper denials and delays while insurers dispute responsibilities. We can help you maneuver the complexities of Medicare/Medicaid coordination, ERISA plan interactions and other coverage disputes. That way, you can rest easy knowing that your claim has been processed fairly and efficiently.
Claims Processing Delays And Administrative Issues
Insurers may use tactics to cause unreasonable processing delays or demand repetitive documentation to delay paying your claim. If that happens, we can help you overcome these cumbersome administrative hurdles and ensure insurers handle your premium payments and claim coding correctly.
ERISA Considerations
ERISA regulations can complicate health insurance claims, affecting bad faith claims and plan differences. We can guide you through administrative appeals and documentation requirements. That way, you can ensure your ERISA rights are upheld. Ensuring your rights under ERISA are upheld.
Evidence And Thorough Documentation Are Key
If you face repeated obstacles with your health insurance claim, know you don’t have to handle this alone. Our attorneys are here and ready to help. We can ensure you have all the correct evidence and learn how to identify and document bad faith practices by your insurer. Let’s fight for the coverage you deserve today. Schedule an initial consultation by calling 920-383-3911 or visiting our contact page. We take cases all across Wisconsin.