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Know how to address “medical necessity” in your case

On Behalf of | Apr 23, 2021 | Delayed And Denied Insurance Claims | 0 comments

You’ve been diligent in paying your insurance premiums to ensure that you can have access to affordable healthcare when needed. Then, the moment comes when you have to rely on that insurance policy to prevent yourself from falling into financial ruin. The only other option is to forego treatment altogether, but that could leave you in a dire position where your condition worsens. That’s unacceptable. But what’s even more unacceptable is when your health insurance claim is denied. When that happens, you need to know why your claim was denied and what you can do to remedy the situation.

The “medical necessity” analysis

Generally speaking, health insurance policies will only pay for diagnostic and treatment services that are deemed necessary to your health and wellbeing. While the phrase “medical necessity” may be clearly defined under government programs like Medicaid and Medicare, private insurance companies more loosely define the term. This means that they may deem “medical necessity” to mean that your doctor is required to perform the cheapest and least invasive way possible. As a result, if the treatment you received or are about to receive doesn’t fall into that category, then your claim may be denied.

Fighting back against your insurance company

Don’t just take your insurance company at its word when it says that your treatment isn’t medically necessary. Instead, diligently work to gather the evidence you need to prove that your course of treatment is, indeed, necessary. This means documenting all interactions with your healthcare providers and your insurance company, educating yourself on alternative forms of treatment, and openly discussing necessity with your doctor.

If you need help with that process, then it might be best for you to discuss your case with an attorney who is experienced in this area of the law. Perhaps then you can recoup the compensation you need to ensure that you can receive the treatment that you need and deserve.