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Private Medicare Wrongful Denial of Insurance Claims

Private Medicare Wrongful Denial of Insurance Claims - medicare forms

Health insurance is there to protect us in our times of greatest need. If you suffer an injury that’s covered by your insurance plan, you should be able to rest assured knowing that treatment won’t break the bank and that you’ll be on the road to recovery soon enough.

In spite of the legally binding nature of insurance plans, some providers routinely reject claims that are perfectly valid. This has been the case with certain Medicare Advantage providers, which have been found by the U.S. Department of Health and Human Services Office Inspector General to wrongfully deny insurance claims that should have been paid out. A recent report from the government watchdog stated that private Medicare plans rejected 18% of claims permitted under Medicare coverage policy. According to the report, these private insurance plans had coverage formulas beyond what Medicare required, and would reject claims on the basis that they lacked the appropriate documents even when the claimant had provided the necessary information. This oversight has left millions of Americans out of pocket and denied essential services that physician reviewers found to be medically necessary.

By rejecting insurance claims that should have been authorized, Medicare Advantage providers are complicit in the denial of urgent medical treatment to those in need. Not only does this pose a serious threat to the health of at-risk patients, but it also constitutes an act of criminal negligence. Violating the terms of agreement leaves culpable insurance providers liable for legal action, and you could be entitled to compensation if you’ve had an insurance claim wrongfully denied.

Our attorneys are on hand to help you bring a negligent private health insurance provider to justice. As a paying consumer, it’s important to stand up to at-fault organizations, not only to recover any damages you should have received with your claim, but also to show the provider that their actions are unacceptable. Holding the offender to account will set an example for the rest of the insurance industry and ensure that other patients receive the medical care they need at an affordable rate. Morgan & Morgan is in the process of building a class action and we’d like to hear from you if you’ve been a victim of a Medicare Advantage insurance claim denial that should have been granted. 

Contact us today to get started, and read on for more information: 

Which Insurance Providers Are Wrongfully Denying Insurance Claims?

Taking a stratified random sample of 500 insurance denials issued by the 15 largest Medicare Advantage Organizations (MAOs) from June 1–7, 2019, the U.S. Department of Health and Human Services found that 18% of rejected claims should have been approved. The evidence suggests that the issue is widespread and that consumers should be guarded when reviewing a dismissed claim regardless of the reputation of the provider.

Can a Lawyer Help With a Wrongful Denial of an Insurance Claim?

Insurance providers agree to pay out on medical services when they meet coverage guidelines. Failure to keep to this agreement leaves them liable for legal proceedings. If your private health insurance provider has rejected an insurance claim that they should have paid out, you’re entitled to pursue a class action. An experienced attorney will be able to maximize the compensation that you’re rightfully owed.

Contact Morgan & Morgan

In the most difficult moments of your life, Morgan & Morgan has your back. The failure of Medicare Advantage insurance providers to keep to the terms agreed upon in their insurance plans is not your burden to bear. As a paying consumer, you’re entitled to any damages owed to you by the culpable organization. Our attorneys are ready to take your call.

If you’ve had a health insurance claim that met the terms of your coverage denied by your provider, Morgan & Morgan will take the lead in your legal battle. Contact us today to get started.