Health Insurance Claims

When it comes to health insurance, an injured policyholder who requires significant medical treatment may find themselves in a situation where they are held hostage to the whims of their insurer. If an insurer denies your claim, underpays your claim, or delays payment, you could be left in financial limbo with no means with which to pay your medical bills.

Though one may believe that their claims are covered by the insurance contract, the insurer benefits a great deal from interfering with the payout. For example, if the insurer wrongfully denies your health insurance claim, and you decide not to challenge the denial (and potentially recovering damages), then the insurer will effectively avoid a payout that they otherwise would have had to honor.

As health insurance providers are naturally in conflict with their policyholders, it is critical that policyholders take an active role in making sure that their claims are fairly considered and processed by their insurance providers. If the insurer fails to act in accordance with their duties under the law, you should connect with an experienced Houston health insurance claim lawyer who can aid you through the process of obtaining a favorable resolution.

Coverage Issues

Difficulties in having your claim processed and accepted can be related to, but are not necessarily limited, to:

  • Category of treatment not covered (i.e., mental health issues not covered by existing healthcare plan)
  • Treatment considered “not medically necessary”
  • Denial on the basis of incomplete evidence
  • Administrative and clerical errors
  • Delayed submissions
  • Valuation of costs does not accurately reflect claim

Pre-Authorization Issues? A Houston Health Insurance Claim Lawyer Can Help

In some health insurance disputes, the policyholder may have failed to obtain pre-authorization from the insurer before receiving treatment. Failure to obtain pre-authorization may result in a claim denial, but the denial will not necessarily “stick.” If you can demonstrate that the treatment is necessary and would have been authorized by the insurer, then you may be able to successfully challenge the denial.

If you have had your health insurance claims wrongfully denied, delayed, undervalued, or otherwise interfered with by the insurer, it’s important that you connect to a qualified Houston health insurance claim lawyer with a track record of success in challenging the decisions of insurance providers and obtaining a favorable result. Depending on the terms of the coverage, your attorney may have to re-file your claim, challenge the denial through an internal administrative process, and eventually take your case to trial.

Here at Berg Plummer Johnson & Raval, LLP, our attorneys have decades of combined experience helping clients litigate health insurance coverage issues and obtain the benefits they deserve. Our track record speaks for itself — over the years, our attorneys have represented clients in numerous insurance disputes, and have recovered countless dollars' worth of benefits on their behalf. Further, our attorneys have been recognized by Martindale Hubbell, Super Lawyers, and US News and World Report as among the best in America.

In both civil litigation and insurance dispute matters, clients tend to have different expectations and limitations. Berg Plummer Johnson & Raval, LLP is committed to providing best-in-class legal representation that is considerate of our clients’ varying financial limitations and strategic needs. To that end, we aim to provide our clients with their choice of fee arrangements that are customized to their particular needs.

Contact Us

Berg Plummer Johnson & Raval, LLP
Berg Plummer Johnson & Raval logo | Houston Business Lawyer 3700 Buffalo Speedway, Suite 1150, Houston, TX 77098
Phone: 713-526-0200 - Fax: 832-615-2665