Affordable Care Act Claims

When first passed, the Affordable Care Act seemed to be a huge step forward for patients receiving medical care. The Affordable Care Act made mental health coverage mandatory for insurance companies and also expanded the level of coverage for other conditions. The expansion of coverage is beneficial for patients, but expensive for insurers. This has led to insurance companies wrongfully denying care that patients desperately need, in particular, insurance companies are denying coverage of long-term care services.

How Does A Health Insurance Claim For Long-Term Care Work?

When a doctor prescribes long-term care, a corresponding claim is submitted to the insurance company. A representative from the insurance company receives updates on the patient’s condition from the treating doctors every day or every few days. If the insurance representative believes the patient has recovered enough to warrant a lower level of care, the representative refers the case to a doctor employed by the insurance company.

This insurance company doctor determines if the current care is medically necessary, or if the patient can receive a lower level care. However, the insurance company doctor never physically examines the patient. They rely on reports from the treating physicians to determine appropriate care.

In many instances, insurance company doctors repeatedly deny expensive, long-term care for patients against the advice of treating physicians. By doing this, patients who need care are discharged from hospitals and suffer serious consequences.

Why Do Health Insurance Companies Deny Claims?

Long-term care can be very expensive, but it is is absolutely necessary for mentally ill patients or patients requiring extraordinary treatments. These patients pay health insurance premiums every month with the expectation that their insurance company will cover the cost of such care if they ever need it. For insurance companies, denying claims for long-term care means saving money.

How Health Insurance Denials Affect Patients Seeking Mental Health Care

Patients in need of long-term mental health care are a heightened risk of injury from a health insurance denial. Patients who are suicidal require around the clock care to ensure they do not harm themselves. Insurance company doctors often transition these patients to a lower level of care because their condition has improved. However, removing these patients from a hospital or in-patient treatment facility removes them from a safe place. Mentally ill patients released from a facility too soon could harm themselves or others.

Other Types of Denied Claims

Patients seeking other types of care also suffer healthcare coverage denials from their insurance companies. Cancer patients, patients with chronic illnesses, patients with pre-existing conditions, or patients requiring any other type of extraordinary treatment also experience routine denials because insurance companies simply do not wish to cover the cost of their care.

What To Do If You Were Denied Care

Denying healthcare coverage puts patients at a serious risk of harm. While all insurance companies have an appeals process that includes an external review, this process can be drawn out and you might not get the coverage you need in time. If you or someone you love was denied coverage and then suffered an injury as a result, immediately contact the experienced trial lawyers at Blizzard Law PLLC today. Our attorneys aren’t afraid to take on large insurance companies. We can help you get the care and compensation you deserve. Call us today for a free consultation to discuss your case.