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How Can an Attorney Help With Insurance Claim Denials?

As most Philadelphia insurance attorneys are aware, the Affordable Care Act (“Obamacare”) includes provisions designed to help patients get a more fair and improved system of reviews of denied insurance claims.

How is this news? In general, people are denied claims in both insurance and employment disability programs on a routine basis. These denials come from both private insurers and the federal Social Security system ­– and are the reason a Philadelphia disability claims lawyer or health insurance claims attorney are necessary in many cases.

For example, when it comes to appealing health plan decisions, the following are already guaranteed to the plan holder (as of March 23, 2010) when the patient has been denied coverage and that patient wishes to appeal the decision:

  • Internal appeals – Your insurer must spell out how your appeal was handled.
  • External review ­– If you are turned down for your claim again by this internal appeal, you can have an independent review organization review the refusal.
  • Consumer Assistance Program – Pennsylvania is a state offering assistance to work through these health insurance claims problems.

On the disability side, appealing a claim denial for Social Security Disability (SSD) or Supplemental Security Income (SSI) requires tenacity and supporting evidence that includes medical records and long-term prognoses, as well as an analysis of your ability (or lack thereof) to generate income by an alternative means. The law firm of Nass Cancelliere., based in Philadelphia, works with individuals who were refused disability payments. The firm also has offices in Media, Pennsylvania and Westmont, New Jersey and can be reached at 215-546-8200 or 856-427-9100.

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