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Bad Faith Insurance Practices and Health Care Denials

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Bad Faith Insurance Practices and Health Care Denials

27 Oct, 2020
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Health insurance provided through your employer helps to offset the high costs of medical care. Unfortunately, it is not uncommon for insurers to act in bad faith, resulting in lengthy delays in payments and unreasonably denied health insurance claims. It is important to be aware of common bad faith practices employed by these companies and the steps you can take to protect yourself. 

What are Bad Faith Health Insurance Practices?

As for-profit businesses, insurance companies make billions of dollars in profits each year. Among the ways these companies protect these profits is by increasing monthly premiums and reducing payouts on claims. Your health care insurance policy is likely filled with fine print, which includes exclusions that prevent them from having to provide coverage in certain situations. 

At the same time, insurance companies are required to follow rules and regulations under the Illinois Insurance Code. These protect the rights of consumers and govern how insurers conduct business. Bad faith practices in which they unreasonably deny or delay coverage are prohibited. Examples of this include: 

  • Intentionally misrepresenting the terms of your health insurance policy;
  • Denying a valid health insurance claim;
  • Unreasonable delays in investigating or paying medical claims;
  • Refusing to communicate with the insured;
  • Requiring you to submit repetitive and needless paperwork;
  • Not providing valid reasons for health insurance claim denials or delays;
  • Paying less than the total amount listed in your health insurance policy. 

Protecting Yourself Against Health Insurers Acting in Bad Faith

If you suspect your health care insurance provider is acting in bad faith, one of the first steps you need to take is to review the terms of your policy. Under the Employee Retirement Income Security Act of 1974 (ERISA), your employer is required to provide a copy of these documents, free of charge and at your request. Carefully look over these documents to ensure eligibility and coverage in your particular situation. 

If the insurance provider is not complying with the terms of your coverage or you have other reasons to suspect they are acting in bad faith, take the following steps: 

  • Keep copies of all insurance-related documents and any correspondence from the insurer you receive;
  • Keep all medical bills and statements relating to your condition;
  • Continue to attend doctor visits and follow all instructions;
  • Speak to our ERISA attorney about filing an appeal or a bad faith insurance lawsuit.   

Contact Our Chicago ERISA Attorney Today

You do not have to pay out of pocket for medical expenses that should be covered by your insurer. At the Law Offices of Michael Bartolic, we protect you against the bad faith practices of health care insurance companies. Call or contact our Chicago ERISA attorney online and request a consultation today. 

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