What to Do if Your Health Insurance Denies a Claim
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 [...]
Jury Awards $200 Million Against Sierra Health & Life for Wrongful Denial of Healthcare Coverage
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, [...]
What Is Medical Necessity?
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 [...]
The Number of Consumers With Medical Bills Denied Might Surprise You [Infographic]
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 [...]
Mental Health Care: Parity and Provisions in Nevada
Health insurance companies owe a duty of care to their clients that includes providing for their mental health care needs. Nationwide, up to 1 in every 5 adults is expected to experience a mental illness in the course of any given year. Of these, it is estimated that up to 4% of adults experience a serious mental illness that substantially affects their ability to function and engage in normal activities. When insurance companies deny or delay coverage for mental health services, they can be held liable for actions [...]
Victim Sues Casino After Severe Beating [infographic]
A tourist filed suit against a casino alleging that the casino failed to maintain adequate security, ultimately resulting in his severe beating. Casinos, like all businesses, are required to keep their premises free from reasonably anticipated or known dangerous conditions. (Article continues below Infographic) The Assault In this case, the plaintiffs were an elderly couple on vacation from Hawaii. They were gambling late at night when the husband, the victim, went to the bathroom before the couple was going to pack for their flight to Hawaii. While the [...]
Discrimination In Health Insurance
A recent injunction and upcoming changes could have a significant impact on discrimination in healthcare and health insurance in the United States. In May of 2016, the Department of Health and Human Services (HHS) issued a final rule that prohibited federally funded health programs from discriminating against individuals based on color, race, national origin, age, disability and sex (including gender identity). On December 31, 2016, the Federal Court ruled to grant a nationwide preliminary injunction that will block the enforcement of certain provisions of that rule. Key Provisions [...]
Dangerously Defective Medical Devices [infographic]
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 [...]
Avea ventilator under recall: May cause death [infographic]
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 [...]
Medical Devices Still Aren’t Much Safer
Medical devices are not safer to use because data needed to identify dangerous devices is not routinely reported in the United States. Health problems caused by medical devices are not uncommon. The number of recalls continues to climb due to several factors. It should be a given that lifesaving devices are closely monitored. That isn’t the case, however. Medical Devices Can Be Dangerous The very devices that people rely on to save their lives can instead wreck havoc. The United States Food and Drug Administration (FDA) is responsible [...]
