It has been the law for some time in New York and New Jersey that you have the right to appeal denials of health insurance claims made by your health insurer. That right is going national now that the Affordable Care Act is finally going to take full effect on January 1, 2014. Even grandfathered plans will now have appeal rights.
Internal and external appeals are not your only way to force the insurance company to pay you what you are owed. While you might first have to engage in the appeal process, if the company continues to deny your claim, or refuses to authorize a procedure, you can enforce your insurance contract in court. In many instances, you might even be entitled to recover your attorney’s fees, or in egregious cases, to punitive damages.
Many companies settle at the sight of an attorney on your side, as they are just trying to push you around.
If you are having an issue with an insurance company, call me at 201-289-5352. We will set up an appointment to review your contract and the claim you have made and determine the best strategy to get your money.