Health Benefit Denials

PRACTICE AREAS

Health Benefit Denials

When a health insurance company denies coverage for essential medical or behavioral health services, families are often left feeling frustrated and unsure of what to do next. At the Law Office of Leigh Anne Hodge, APC, we help parents challenge wrongful insurance denials and fight for the benefits their child is entitled to under the law. Whether your case involves therapy services, assistive devices, mental health treatment, or specialized medical care, we guide families through the appeals process, litigation, and state or federal court action if necessary. With extensive experience in healthcare and insurance litigation, we know how to navigate complex policies and push back against unfair denials. Our firm works to ensure that insurance companies honor their obligations so your child receives the care they need.

If your child’s necessary medical services have been denied, we are here to advocate for your family and take legal action if needed.

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How can a lawyer assist if my child's health insurance claim is denied?

A lawyer experienced in health insurance disputes can provide valuable assistance when your child's claim is denied. They can:

Evaluate the Denial: Review the insurance company's reasons for denying the claim and assess the validity of their decision.
Guide the Appeals Process: Assist in preparing and submitting an internal appeal to the insurance company, ensuring all necessary documentation and evidence are included.
Pursue External Review: If the internal appeal is unsuccessful, they can help request an external review by an independent third party, which may overturn the denial.
Litigate if Necessary: If appeals are unsuccessful, an attorney can file a lawsuit against the insurance company for wrongful denial, advocating for your child's right to necessary medical services.

Engaging a lawyer ensures that you navigate the complex appeals process effectively and enhances the likelihood of securing the required health benefits for your child.

What steps should I take immediately after receiving a health insurance denial for my child's treatment?

Upon receiving a denial, consider the following actions:

Understand the Denial: Carefully read the denial letter to comprehend the specific reasons for the refusal.
Consult Your Child's Healthcare Provider: Discuss the denial with your child's doctor to gather supporting medical evidence that justifies the necessity of the treatment.
File an Internal Appeal: Submit a written appeal to your insurance company, addressing their reasons for denial and providing additional documentation as needed.
Seek External Review: If the internal appeal is denied, request an external review by an independent organization to reassess the claim.
Consult a Health Insurance Attorney: If the denial persists, consult an attorney specializing in health insurance disputes to explore legal options and ensure your child's rights are protected.

Taking these steps promptly can significantly improve the chances of overturning the denial and securing necessary medical services for your child.