Is a denied health insurance claim a breach of contract?

Medical costs have skyrocketed in Florida in recent years. This is why it’s important for Melbourne residents to have health insurance. Without it, they risk not getting the health care that they need or racking up medical bills that can easily bankrupt them. If you have health insurance, the denial of a claim can leave you financially vulnerable. There are reasons your claim may be rejected and steps that you should take if it occurs.

One of the first steps that you should take is to verify why it was rejected. There are some common reasons why insurers deny claims.

Health insurance companies often deny claims because they’re not submitted punctually or have typographical errors. They may also deny your claim if you maxed out your policy limitations, saw an out-of-network provider or failed to get pre-authorization or a referral.

Claims can also get rejected if a procedure or other services aren’t covered by your policy. This can happen if you have a cosmetic procedure.

What many insured people don’t realize is that they and their insurance company are in a contractual relationship. As the insured, you pay a monthly premium. In exchange, your insurance company covers certain procedures, services and medications on your behalf. If they fail to uphold the contractual agreement, then you may be eligible to refile your claim or even file a bad faith lawsuit against them.

If your health insurance company refuses to conduct an investigation into your denied claim or unreasonably delays it, then they may be deemed to have acted in bad faith. If they refuse to accept the evidence that you produce or fabricate their own, a judge or jury may ultimately decide that they’ve acted unfairly.

Breach of contract lawsuits can be filed by individuals and businesses. One must accuse the other of having failed to comply with the terms of their agreement. If evidence is produced proving that a breach occurred, then the breaching party may have to offer a remedy for the harm that they caused. An attorney can help you understand whether you have a valid claim and if so, how to proceed from there.

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