Consumers who for years pay hefty insurance premiums only to later be denied health coverage owed them often turn to lawsuits against their health insurance company. While it's permissible for a patient to sue their health care provider for not providing resources that insurance premiums supposedly paid for, it's important to have certain facts in order before incurring costly legal bills atop already existing medical bills.
Contact the department in your particular state charged with regulating the insurance companies operations within that state. Find out if that insurance department has a division specializing in health insurers and their beneficiaries. If so, they can provide you with specific guidelines to follow in order to start the appeals process. It is extremely important for policy holders to adhere to all time deadlines and specific requests for paperwork, or they run the risk of having their insurance provider claim that the policy holder, also called the beneficiary, was noncompliant, leading to a denied appeal.
Read your insurance policy for specifics covered by the policy. Often a policy holder feels that an emergency room visit to the hospital for flu symptoms is warranted, but their policy may specifically state that no coverage is granted for ER visits other than true emergencies such as broken bones or head trauma sustained in an automobile accident. Before proceeding to a lawsuit against the health insurer for not providing a specific service, be extremely certain that specific service was in fact covered by your policy.
Since lawsuits take lots of time and lots of money, consider arbitration before filing suit. This can prove to be an effective means of communication between you and the health insurer and often results in a satisfactory settlement for both parties without having to resort to a lawsuit.
Keep excellent records of every document relating to your insurance policy and each communication that has passed between you and the health insurance company regarding the denied health claim. You will need all of this accuracy should you proceed to a lawsuit. Don't depend upon your memory to recall what was sent and when or what was said and by whom. The legal system respects evidence that is in black and white, written records of when and where discussions took place and with whom.
Contact an attorney specializing in lawsuits against health insurance companies. Bring all your documentation with you when you have a consultation and only proceed with a lawsuit if both you and your attorney agree that you have a solid case. The best way to win a suit against a health insurer is with solid evidence and reason backed up by written documentation on your side rather than emotion and hysteria.