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If you are like most consumers, you have seen the feel-good insurance commercials. The insurance companies claim to have only your best interest at heart, and promise to be there when things go wrong. Of course you believe them. After all, you pay your premiums every month. What reason would they have to deny your claim? You might be surprised. 

The Ugly Truth About Insurance Companies

Insurance companies are for-profit businesses, and, like most for-profit companies, they are in the business of making money. They cannot reasonably make money if they are busy paying out claims. So they do everything they can to deny them. 

Some use intentionally confusing wording and obscure clauses that their customers could not reasonably interpret. Others offer rewards to their employees who have the lowest payout quotas. Some will even go so far as to use shady practices, such as locking claims in a safe to delay the process so significantly that the customer eventually gives up. 

Sound unfair? It is! Yet it is an everyday issue within the insurance industry. Thankfully, there are some things that consumers can do to mitigate the risks of having their claim denied. 

Never Handle a Claim Alone

First and foremost, consumers should avoid trying to file a personal injury claim on their own. Instead, they should seek the assistance of an experienced personal injury lawyer. Medical insurance claims are somewhat different since, typically, the doctor or office staff initially submit the claim to the insurance company. Those who need to file a claim against their homeowners insurance should seek guidance from someone other than their insurance company since some have been known to drop their customers for even inquiring about a possible claim. 

If Your Claim is Denied or Delayed

Should you experience a denial or delay of a claim, either because you already filed it without assistance, or because of the insurance company’s shady tactics, it is important that you seek experienced assistance before addressing the issue. 

At Drost, Gilbert, Andrew & Apicella, LLC , we have the knowledge, experience, and resources you need to navigate through an insurance claim denial. Dedicated to your best interest, we will fight to get you and your loved ones the fair settlement that you deserve. Learn more about how our Rolling Meadows insurance claim dispute lawyers can assist with your case. Call 847-934-6000 and schedule a consultation today.

About the Author: Attorney Ken Apicella is a founding partner of DGAA focusing in the areas of personal injury, employment, insurance coverage disputes, and civil litigation. Ken earned his J.D. from DePaul University College of Law in 1999. He has been named a SuperLawyers Rising Star and a Forty Illinois Attorneys Under Forty to Watch. Ken has written and lectured for the Illinois Institute for Continuing Legal Education and regularly serves as a moderator at Northwest Suburban Bar Association's Continuing Legal Education seminars.

According to data from the health insurance industry, approximately one in 14 of all health insurance claims are denied by the insurance companies. Worse yet, only about half of all patients who appeal their claims end up winning. Much of the time, this subsequent denial is due to a lack of experience or understanding of the health insurance appeals process. If you or someone you love is facing a denied health insurance claim, the following information can help. 

Understanding the Most Commonly Denied Claims

Before going up against a denied claim, it is important to understand why it was not covered by your insurance company. This can help you plan a strategy, and may even provide you with the knowledge you need to fight back. For example, you might receive a denial for an unauthorized service or procedure if your doctor failed to receive preauthorization. Alternatively, the denial could be due to an error in coding (the method doctors use to bill for procedures), or because a critical piece of data was entered incorrectly. This happens in about 10 percent of all claims. Other reasons that a claim might be denied could be related to a billing for the same procedure on the same day, or because you have allegedly exceeded the maximum number of times a procedure is allowed. Denials because a plan does not cover a procedure are also common. 

Why Patients Should Not Try to Fight Denied Claims Alone

Although patients can and sometimes do fight back against denied claims on their own, it is highly discouraged. This is not just because you could be denied, yet again, possibly leaving you responsible for a bill you cannot and should not pay, but also because the process is difficult and complex. It is an added stressor in your life - one that you may not need. This can be especially true for those who suffer from severe and/or chronic injuries, illness, or disabilities since they are more prone to insurance claim denials and far more likely to struggle with the appeals process due to a lack of time and/or energy.

Our Rolling Meadows Insurance Dispute Lawyers Can Help

Fighting a claim does not have to be an impossible feat. Instead, let Drost, Gilbert, Andrew & Apicella, LLC help you with the process. We handle all the legal details, protect your interests, and fight for a favorable outcome. Learn more about how we can assist you. Call 847-934-6000 and schedule your consultation with our Rolling Meadows insurance dispute lawyers today.

About the Author: Attorney Ken Apicella is a founding partner of DGAA focusing in the areas of personal injury, employment, insurance coverage disputes, and civil litigation. Ken earned his J.D. from DePaul University College of Law in 1999. He has been named a SuperLawyers Rising Star and a Forty Illinois Attorneys Under Forty to Watch. Ken has written and lectured for the Illinois Institute for Continuing Legal Education and regularly serves as a moderator at Northwest Suburban Bar Association's Continuing Legal Education seminars.