You have paid your insurance premiums, so why has your insurance company denied your medically-necessary claim? The insurance industry works around risk analysis; it knows that out of millions of customers, only a fraction will challenge a denied claim or a low settlement. You do not have to be part of the silent majority when you have a New York HMO insurance misconduct lawyer from Buttafuoco & Associates on your side.
Call today to schedule a free, no-obligation consultation to discuss filing a bad faith claim today: 1-800-NOW-HURT.
What is HMO insurance misconduct?
Your insurance company owes you a duty to review your claims promptly and with an unbiased eye. It should approve care based on your insurance contract and assist you in negotiating a fair rate for care outside of your plan.
When an insurer fails to hold up these duties, it might be liable for HMO insurance misconduct, also known as “bad faith.” This bad faith comes in several forms:
- Unwarranted claim denial with no reasonable explanation for the denial
- Failure to verify receipt of a claim promptly
- Unreasonable amounts of paperwork to execute claims and approve procedures or medications
- Incomplete or careless claim investigations
- Asking you to file a third-party claim or request a discount from the provider before it will look at your claim
These are all examples of the insurance company ignoring you and your needs. There are also situations where the insurance company might become a nuisance with constant calls asking for unrelated records or information you have already given.
Regarding Claim Denials and Low Offers
The insurance company has a right to deny a claim if it feels it is not necessary or within the scope of your medical care. Some valid examples are:
- A refill for a 30-day prescription you just filled five days ago
- Botox for cosmetic-only purposes
- Claims it feels are fraudulent or inflated by the doctor or hospital
However, when an insurer denies a claim for medically necessary care without explanation, you may be able to file a bad faith claim against the insurer. In many cases, simply letting the insurance company know of your plans to file a bad faith claim will prompt it to offer a settlement at or above your original amount.
If the insurer still refuses to offer you an adequate amount, you can take the insurer to court. For help filing a bad faith claim, call a HMO misconduct attorney in New York.
How can an attorney help me file my bad faith claim?
If you feel that your insurer is not treating your claim with the care it deserves, you have the right to file a bad faith claim, but dealing with HMO insurance companies is a tedious and frustrating experience. You should be able to focus on getting the healthcare you need, rather than handling paperwork and gathering evidence for your claim.
A knowledgeable HMO misconduct attorney can handle gathering evidence and communicating with the insurance company and its attorneys.
The New York HMO misconduct lawyers at Buttafuoco & Associates have the experience and knowledge necessary to go up against the biggest insurance companies. We know how important medical care is to our patients, and we do everything in our power to make things right.
Call 1-800-NOW-HURT to schedule a free case review. We will learn more about your case and discuss any HMO insurance misconduct your insurer might have engaged in. If we believe that your insurer broke its legal duty to you and acted in bad faith, we can begin the steps to hold it accountable and get you the settlement you need and deserve.
Contact us today.
