![]() ![]() Anthem can deny an ER claim if they later consider it to have not been an emergency. The denials are for ER visits that the insurance company deems “unnecessary.” Anthem policyholders may be scared to visit emergency departments because Anthem will decide after the fact what a real emergency is. Insurance giant Anthem sometimes unlawfully denied claims for certain treatments and emergency room services, leaving patients with big medical bills. Anthem Refusing to Cover Certain Medical Treatments If you have experienced Anthem medical necessity denial, take back control of your health by calling a Stop Insurance Denial Law Firm attorney. While some denials are honest mistakes, most of them are completed intentionally and meant to look after Anthem’s bottom line. But even so, they can deny your treatment and claim by stating that what your doctors have recommended or order isn’t medically necessary. However, Anthem requires their policyholders to submit a pre-authorization request prior to receiving any treatment, procedures or purchasing any medical devices and supplies. Your doctor is trained, qualified, and has the experience needed to establish your medical needs. The insured sought out-of-network services, whose benefits are different from in-network benefitsĪs a medical patient, you trust your physician to recommend the most appropriate tests, procedures, treatments, and medical devices for whatever ailment you may have. The insured had a procedure or treatment that was not covered under the policy The policyholder received two services in one day The policyholder did not reach their deductible The treatment sought is experimental or investigational The medical device or treatment sought is not medically necessary ![]() ![]() Reasons for Anthem insurance claims denials include: This can be extremely enraging for policyholders who faithfully live up to theirduties and pay their premiums every time they’re due. In some cases, insurance giants may do everything they can to deny claims so as to protect their bottom line. Common Reasons Anthem Gives for Insurance DenialsĪnthem, like any other insurance company, is in the business of providing insurance and of generating profits. The attorneys at Stop Insurance Denial Law Firm can work with you to advocate for your rights as a policyholder in order to get you the coverage you need and deserve. An Anthem insurance denial appeals attorney can help you appeal your claim. If you believe Anthem is illegally denying your claim, you shouldcontact a knowledgeable and experienced attorney. They’re obliged to follow both state and federal laws. If your insurance claim has been denied and you're in a state of confusion, you may be pleased to learn that insurance carriers cannot just make their own rules as they go along. You may be worried, shocked, angry, and probably wondering if you should just accept Anthem’s decision concerning your claim or maybe there’s something else that you can do. Then one day, you receive a telephone call or letter denying your claim. You followed Anthem’s rules and regulations when it came to paying your premiums, receiving health care, and submitting your claim. ![]() Many people rely heavily on their insurance in a way that even a small claim denial can result in substantial financial struggles. Individuals and families purchase health care insurance for peace of mind and should they fall ill or get injured, they expect their insurer to step in and pay for medical expenses. But even with such a massive consumer base, Anthem is no stranger to unlawful insurance denials. However, Anthem also provides other related plans, including disability insurance benefits, long-term care insurance, life insurance, behavioral, dental, vision health benefits services, and flexible spending accounts. This means that Anthem is the leading source of medical insurance benefits in the United States.
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