A serious medical condition, such as cancer, multiple sclerosis, significant back problems or a significant accidental injury or other serious sickness or injury can cause severe financial hardship. Medical bills can be significant and even overwhelming if a claim is denied by one's health insurer. Also, sickness and injury can prevent one from working, thereby, calling into play long term disability benefits which provide income benefits to prevent or alleviate the financial hardship from disability. Both health insurance and long term disability insurance plans are usually governed by ERISA. At the Foster Law Firm, we help people navigate the complex regulations set forth by ERISA or other applicable laws to obtain benefits.
Helping Individuals Recover the Benefits They Deserve
Contact the Foster Law Firm. While our office is located in Greenville, South Carolina, we have the experience, commitment and resources to help clients not only in South Carolina, but, also, in North Carolina, Georgia, Florida, Tennessee, Virginia, Alabama, the Southeast, and throughout the nation.
Health Insurance Benefits - Insurance Claims Process [ Click here if you are interested in Long Term Disability Benefits]
Attorney Nathan Bax, of Foster Law Firm, has extensive knowledge and experience guiding clients through the process of obtaining health insurance benefits. He has handled claims at all levels, from filing the initial claim through the appellate court level and every step in between. The firm even has experience handling ERISA cases all the way up to the United States Supreme Court.
There are numerous companies who insure health insurance plans. The most common, in the firm's experience, are BlueCross and BlueShield plans, United Healthcare, Aetna, Cigna, and Assurant Health (formerly known as Fortis). Nathan Bax has extensive experience with and frequently handles cases against all of the aforementioned insurance companies as well as many more.
With health insurance claims, there can be any number of reasons for which an insurance company might deny a claim. However, the most common basis for denial are:
- the assertion that a treatment or service is not "medically necessary";
- the assertion that a treatment or service is for a condition that is "pre-existing";
- the assertion that a treatment or surgery is "experimental" or "investigational";
- the assertion that a treatment or surgery is "cosmetic";
- the allegation that there was a misrepresentation in the application for insurance which voids coverage;
- a specific exclusion for a particular procedure such as gastric bypass, weight reduction or obesity treatments or dental or orthodontic procedures among many others;
- because a treatment or service is related to an automobile accident or other accidental injury;
- because a treatment or service is for a work-related injury or an injury covered by a Workers' Compensation law;
- because treatment or service is related to an injury that was caused by intoxication, alcohol, or drug use.
Nathan Bax has extensive experience with and frequently handles cases involving all of the above basis for denial and many others.
If your claim for benefits is denied, you will need to adhere to the strict 180 day appeals process. There are specific deadlines and requirements that must be complied with. Therefore, time is of the essence and it is critical to have an experienced ERISA attorney on your side to improve the likelihood of prevailing in the appeal or for improving your chances in court. Learn more about health insurance appeals.
Experienced Health Insurance Attorney
E.R.I.S.A. regulations do not govern private health insurance policies or employee benefits for local, county, state, or federal government employees. Through his experience and understanding of applicable insurance and administrative laws, Attorney Nathan Bax is also prepared to help individuals whose claim is not governed by ERISA with initial claims, appeals, and litigation.
More Information about E.R.I.S.A. and Health Insurance Benefits:
- What to Expect with Your E.R.I.S.A. Claim
- Firm's Experience with E.R.I.S.A., Employee Benefits, and Insurance Cases
- The Firm's Recent E.R.I.S.A. and Employee Benefit Cases
- Our Attorneys in the News on E.R.I.S.A. and Insurance Matters
- Our History of Speaking Engagements on E.R.I.S.A. and Insurance Matters
- Recent and Upcoming Speaking Engagements on E.R.I.S.A. and Insurance Matters
- E.R.I.S.A. Links
- E.R.I.S.A., Employee Benefits and Insurance Overview
- Contact Us Regarding an ERISA or Insurance Question
- Health Insurance Benefits
- Life Insurance and Accidental Death Insurance Benefits
- Long Term Disability and Disability Benefits
If you need assistance with a claim for health insurance benefits or have been denied health insurance benefits, trust in the experience, professionalism, and dedication of Attorney Nathan Bax at Foster Law Firm. Call 866-279-9772 or e-mail us to schedule a consultation.