What Are My Options if My Insurance Claim is Underpaid or Denied?

When you suffer a personal injury, your first option is almost always going to be your own health insurance plan. After all, that’s why we take out and pay for these plans every month. Sometimes, however, these plans come up short and your provider either denies the claim or only agrees to partially pay for what you’re owed.

In our frequent dealings with these companies, we know the tricks they’ll often lean on to get out of paying what is owed. Our team works with clients to sort through the insurance claims process and make sure a denied or underpaid claim doesn’t cripple them financially. It’s important to understand that the initial decision by your insurance company is not the end of your case. You have options to get what you’re owed.

Paying Out of Pocket

Before we get to disputing the ruling you get from your insurance company, you do actually have the option to pay out of pocket for whatever costs remain uncovered. We’re obviously not recommending this option, especially if you believe the ruling to deny or underpay your claim was correct. Appealing or litigating your case can be expensive if your case fails, so it’s important to be sure when proceeding with the following options.

Appeal Through Your Insurance Plan

When an insurance company decides to deny or pay just a portion of the claim, they’re required to inform you why the decision was made. On top of this, the company needs to inform you about the options available to appeal the decision.

In general, your insurance company will allow you to have your claim reviewed again. This internal process must be done quickly to provide a fair and just review of your claim. These reviews aren’t just a formality and people do have success with internal appeals at times. However, these appeals don’t generally succeed as often as third-party appeals.

Litigate Your Claim

You’re more likely to find success in appealing through a third party. In this case, you will retain an attorney with experience in these cases to defend your claim. The insurance company has its own attorneys who will fight to have their initial decision upheld, so it’s important to be prepared and hire the best attorney to be by your side.

In this case, the third party will make the ultimate decision about whether or not your claim should be paid out and how much of the claim needs to be covered by your insurance plan. To make sure you get the most out of your Alabama insurance litigation, contact Attorney John M. Totten.