Medical Devices and Health Insurance Denial
Miami Health Insurance Lawyer Though healthcare insurance denials are common, many policyholders are shocked when they are denied benefits for having received a medical device at the behest of their treating physician. In truth, healthcare insurers are built to deny as many claims as they can reasonably justify. They profit and thrive on the expectation that you will not challenge their decision and that they will “get away” with not having to pay out the benefits that you might be owed. We can help. If you’ve had your healthcare insurance claim denied on the basis that your medical device is not covered by your policy, or for any other reason, then you may be entitled to challenge their initial decision and secure benefits. Contact Ver Ploeg & Marino, P.A. for further assistance with your dispute. Let’s take a brief look at the basis for such denials. Medical Necessity Generally speaking, health insurers deny benefits for medical devices on the basis of medical necessity, which is a rather broad concept. Every insurance policy is different, of course, and the definition of “medical necessity” can vary considerably from plan-to-plan. Most share certain commonalities, however. Determining whether a device is medically necessary requires a comprehensive evaluation of factors: whether the use of such device is clinically appropriate, whether it has been provided in accordance with generally accepted standards of practice, and whether it is no more costly than competing devices or therapies that could produce an equivalent result. For example, suppose that you […]