Category: Health Care Litigation

Why Are Surgical Procedures Commonly Denied by Insurance?

Published on September 10, 2024, by Law Office of Matthew L. Sharp

Health Care Litigation

The good news is that 92.1% of Americans had health insurance at some point in 2022. That is based on information collected by the United States Census Bureau. The bad news is that insurance doesn’t always provide coverage for all procedures. If you or someone in your family are dealing with health issues, you need to know why surgical procedures are commonly denied by insurance. The following are some of the common reasons why a denial occurs: The Insurance Policy Does Not Cover the Procedure Two common types [...]
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Does Health Insurance Cover the Cost of a Stay in the NICU?

Published on April 30, 2024, by Law Office of Matthew L. Sharp

Health Care Litigation

The neonatal intensive care unit (NICU) is a crucial facility that provides specialized care for newborns who are premature, have low birth weights, or face other medical challenges. While the NICU serves as a lifesaving haven for these vulnerable infants, the financial burden it imposes on families can be overwhelming. Many parents wonder whether their health insurance will cover the substantial costs associated with a NICU stay. According to the American Medical Association (AMA), "Daily NICU costs [typically] exceed $3,500 per infant, and it is not unusual for [...]
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Insurance Premiums Skyrocket Amid Rising Health Care Costs

Published on January 16, 2024, by Law Office of Matthew L. Sharp

Health Care Litigation

A recent report published by the national non-profit foundation formerly known as The Kaiser Family Foundation (KFF) highlighted how annual family premiums for health insurance coverage are steadily increasing, and this trend is expected to continue in the foreseeable future. As for what is behind the skyrocketing insurance premiums, it not only centers around rising healthcare costs but also on other factors. Below, we'll explain more about what is driving costs and how much premiums are being impacted. Where Current Employer-Sponsored Health Insurance Rates Stand The researchers who [...]
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What to Do if Your Health Insurance Denies a Claim

Published on November 22, 2022, by Matthew Sharp

Health Care Litigation

Knowing what to do if your health insurance denies a claim can increase your chances of getting the decision overturned. You have a legal right to appeal the denial decision through either an internal or external appeal.  An internal appeal involves requesting your health insurance company to take a second look at your claim and reconsider its decision. An external appeal involves asking an independent third party to review your claim and decide whether your insurer should pay the claim.  A bad faith insurance lawyer can discuss reasons [...]
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Jury Awards $200 Million Against Sierra Health & Life for Wrongful Denial of Healthcare Coverage

Published on April 12, 2022, by Matthew Sharp

Blog, Health Care Litigation, Insurance Bad Faith, Insurance Bad Faith Disputes

I want to thank you all for the very kind words and thoughts. Those comments are greatly appreciated. I want to let you all know briefly what Eskew v. Sierra Health & Life was about. I am sure there will be a time when I have the energy to talk about the trial strategy, the trial, and our impression of why the jury made the right decision. Three years ago, Doug Terry (a great lawyer from Oklahoma City) and I believed in a fine lady from Las Vegas, [...]
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What Is Medical Necessity?

Published on October 12, 2018, by Matthew Sharp

Health Care Litigation

Proving medical necessity can play an important role in a bad faith insurance case when a company denies a claim. Most health plans will not pay for healthcare services that are not deemed to be medically necessary. Medical evidence is required to show the validity of a claim. Even valid claims, however, are sometimes denied. Contact an insurance claim lawyer for help with your case. Medical Necessity Definition What is medical necessity? Health insurance companies provide coverage only for health-related services that are medically necessary, meaning medical services [...]
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The Number of Consumers With Medical Bills Denied Might Surprise You [Infographic]

Published on September 27, 2017, by Matthew Sharp

Health Care Litigation

As many as 53 million insured Americans are denied payment for medical bills by their health insurance company. Recent medical data shows that 24 percent of insured individuals are denied payment for prescribed medical treatments.   Denied Payment for Medical Treatments Over the last few years, many Americans have gained health insurance with the help of healthcare reforms through Obama Care (Affordable Care Act), however, many of those insured individuals with persistent conditions and chronic illnesses are facing medical billing denials for treatments. According to data from the [...]
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Dangerously Defective Medical Devices [infographic]

Published on September 15, 2016, by Matthew Sharp

Health Care Litigation, Infographic, Product Liability

Improperly tested and manufactured medical devices cause thousands of severe injuries and fatalities each year. Loose regulations that allow for selective reporting exacerbate the risk and put patient lives at risk. Patients who have suffered adverse events due to defective devices can pursue compensation via a Reno defective medical device lawyer. Hip Replacements From 2002 to 2013, there were 578 recalls from six manufacturers of hip replacement devices. Stryker had the most with 231, and DuPey had the second greatest number with 150. Devices manufactured by these companies [...]
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Avea ventilator under recall: May cause death [infographic]

Published on August 12, 2016, by Matthew Sharp

Health Care Litigation, Infographic, Product Liability

CareFusion Avea ventilators recalled because of risk of death or serious injury A Class 1 recall has been issued for the CareFusion Avea ventilators. Class 1 recalls are the most serious recalls issued by the Food and Drug Administration, meaning that the defects may result in serious injuries or death. The recall for the ventilators is due to a defective fuse on the alarm board of the devices, which might lead to unexpected shutdowns. When a ventilator shuts down, the patient might not receive sufficient oxygen. Avea ventilators [...]
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