Insurance and Claims: Tactics the Most Prominent Companies Use
Recently, the shooting death of a United Healthcare CEO made headline news in America and around the globe. Many insurance company executives feel nervous, and rightly so. Privatized healthcare in this country continues to cause strife and tension.
While not all insurance companies use nefarious or underhanded policies, some of them do. Insurance companies frequently deny customer claims, and when that happens, the individual trying to recoup their money or to get the company to pay for their care often feels angry or helpless.
Often, if an insurance company won’t pay out a claim, you will have to grapple with them for weeks or months to get the cash you feel you’re due. You might also have to put off a vital medical procedure because you don’t feel like you can afford to pay for it out of pocket.
You may have to get yourself a lawyer who can help you in such an instance. Whether you take this action or not, you should know about some of the tactics these companies can use. Let’s talk about some of the more common ones that prominent companies use right now.
Saying You Don’t Need a Lawyer
If you have a health insurance claim that your insurance company won’t pay, getting an attorney makes sense. You will want one who knows all about the medical insurance field and who has dealt with these cases a lot on the past.
However, if you’re negotiating with the insurance company, don’t let it surprise you if they say you don’t need a lawyer. These companies often prefer that you negotiate without someone in your corner who knows the law.
Remember that you can still get a lawyer, even if the health insurance company says you don’t need one. They have no legal grounds to prevent you from retaining an attorney if you want one.
Using a Recorded Statement Against You
If you contact a health insurance company on the phone about a claim that they denied, you should always assume that they’re recording the call. They do this because they’re hoping you will say something that they can use against you later.
The person you talk to might make deliberately confusing statements or ask questions to try and get you to say that you don’t have a very urgent medical need or that you had a preexisting condition. That’s one of the reasons why it’s helpful to have a lawyer. They can call and talk to the insurance company on your behalf to keep you from saying something that might hurt your standing.
Misinterpretation of Policy Language
You may also have a situation where the health insurance company that issued your policy will deliberately misinterpret some of the language in it. If you do not have a lawyer, then it is even more likely that they will try this strategy.
If they say that vague language in the policy means they should give you less money, or that they should deny the claim altogether, then you may need to take up the matter in court.
Downplaying an Injury’s Severity
A health insurance company that holds your policy may also downplay the severity of an injury that you have sustained. They will do this to deny a claim. They might say that you do not need surgery, medication, physical therapy, or something else.
Even if your doctor says that you have a more serious injury, then you might have to battle it out with the insurance company to get a satisfactory resolution. While having a doctor on your side will definitely help your cause, having a skilled lawyer should aid you even more.
Blaming You for the Injury
Maybe you feel there is no doubt you can blame someone else who caused your injury. For instance, perhaps you slipped on a wet patch in a store and broke your ankle. The store didn’t have a sign up stating they had a potentially hazardous situation.
If you need surgery, the insurance company might try to argue that you should have seen the wet patch. You can probably think of several more situations that might develop in this way.
The insurance company will try to say that because you didn’t pay attention or demonstrated negligence, that they should not have to pay for your medical bills.
Offering a Low Settlement Amount
The insurance company might also state that they agree they should give you some money, but they will only give you a lower settlement amount that won’t completely cover your medical bills. That tactic sometimes works because the insured might feel that it’s better that they walk away with some money rather than none.
Remember that if you accept a settlement and sign paperwork indicating that you are satisfied, you can’t come back to try to get more later.
Delaying the Claims Process
A health insurance company might also try to do everything they can to drag their feet during the claims process. They might say they need you to resend information that you already gave them. They may say they need more documentation. They might take the longest time that the law allows before giving you their decision.
If a health insurance company delays a claim long enough, that is often what makes it more likely that you will take a lower settlement amount. They usually feel that a person will take less money just to conclude the long, laborious process.
While the for-profit insurance business might seem sleazy, not all companies act this way. However, remember that if a company can keep more of your money, more of it can end up in the pockets of the company’s prominently-placed executives.
That is why you should strongly consider getting a lawyer who knows this legal niche if you are trying to conclude one of these cases satisfactorily. Contacting an attorney does not necessarily mean you will get any money, but it makes that outcome considerably more likely.
