Denied Coverage for Mental Health? Here’s How to Challenge Your Health Insurance Company.

July 22, 2024

Mental Healthcare Is Often Misunderstood

Every day individuals in Oklahoma and across the country receive word from their insurance companies that their mental healthcare claim was denied. This is a longstanding problem, although things are much better today than they have been. Yet, when it comes to mental health benefits, claims are still regularly challenged.

Those whose benefits are denied are saddled with significant costs, and many are simply unable to get the treatment they so badly need.

The barriers to mental healthcare are frustrating – and significant.

It is important to realize that mental healthcare is just as necessary as care for the physical ailments from which many suffer. In fact, the government recognizes that “mental and behavioral health services are essential health benefits.”  Health insurance plans through the marketplace are required to cover a broad range of treatments and include pre-existing mental health conditions.

If your health insurance company has denied your claim for mental health services, don’t despair. You have the right to file an appeal and challenge their decision. That said, the process can be trying. Luckily, help is available. Engaging the services of an Oklahoma denied claims attorney who is experienced in appealing mental health claims can improve your chances of receiving compensation and relieve you from the stress associated with managing the process and negotiating a settlement on your own.

Why Mental Health Coverage Gets Denied

Insight Is Valuable

The reasons why insurance companies deny mental health claims are broad-based and numerous. And, while many companies profess to cover mental health claims, they can be incredibly creative when it comes to reasons for denying them.  These are some of the most common reasons why mental health claims are denied:

• Lack of medical necessity
• Absence of preauthorization
• Incomplete patient information
• Lack of documentation
• Service provided goes beyond covered amounts
• Errors in billing codes
• Non-compliance with submission timeframes.

Of course, other reasons for denial do exist. If your claim was denied, you should review your insurance provider’s documentation to understand why. An Oklahoma denied health insurance attorney can help you with this process.

Your Path to Fighting Back

You Have Options

The combination of the bias against mental healthcare in this country and insurance companies’ goals of maximizing profits by minimizing paid claims results in countless denials for mental health claims each year. For those involved, the impact is devastating. This care is just as necessary as insulin is for diabetes or chemotherapy is for cancer.  For insurance companies, and many others, to view it as optional is not only frustrating, but also dangerous.

If your claim for mental health treatment has been denied, your best course of action is to file an appeal. Depending upon the reason for the denial, receiving qualified guidance and taking the right steps can increase your chances of receiving compensation.

Inaction on your part has very real consequences. It signifies that you accept your insurance company’s decision and results in your shouldering the cost of your treatment.

Be Proactive – File an Appeal

Appeals are important; they allow you to challenge denials and underpayments. During this process, both a denied claims attorney and your mental health provider can play valuable roles. Your attorney can manage the process on your behalf, confirming your appeal is complete and making a strong argument for compensation. Your provider can help with documentation to prove that the treatment you received was medically necessary.

Upon receipt of a denial, you should:

• Carefully review the denial letter to ascertain exactly why your insurance company refused to pay your claim
• Read your health insurance policy to understand the services that are covered and the claims submission process
• Meet with your provider to review the denial paperwork and request a letter detailing the medical necessity of the treatment provided
• Draft an appeal letter making sure to include dates of service, policy number, and your name, email, and telephone number. Always refer to their reasons for denial and state clearly why you disagree.  Make sure to attach all relevant information.

An Oklahoma denied claims attorney can help manage this process on your behalf, including reviewing your policy and the denial letter, drafting your appeal, and communicating with the insurance company.

If negotiations are unsuccessful, this professional can help file a bad faith actions lawsuit and identify, calculate, and substantiate damages.

Mental Healthcare IS Healthcare

Don’t Accept Discrimination

The stigma regarding mental health and its care in Oklahoma and across the country sadly still exists. The work so many have done to have their struggles rightly identified as real medical issues is incredibly valuable and has resulted in many insurance companies’ including coverage for treatment in their policies.

Unfortunately, this work is meaningless if the inclusion is perfunctory, and the care provided is viewed differently than physical medical issues. Those who have been proactive regarding their mental health should be commended, and their insurance companies should provide benefits according to the language of the policies they issue.

If you have been denied coverage for mental health treatment by your insurance company, it’s time to take action. Consider engaging an Oklahoma denied claims attorney.

Doug Terry Law Can Help You Appeal Your Denied Mental Health Claim

The team at Doug Terry Law is well aware of the long-standing existing discrimination insurance companies practice concerning mental healthcare. In an ongoing goal to maximize profits by minimizing paid claims, letters of denial for mental healthcare are common.

Our team recognizes the importance of mental healthcare and believes those who seek the treatment they need should be able to rely on their insurance companies to do right by them.

When you contract for a service, it is realistic to expect your provider to follow through.

Doug Terry began his career working for insurance companies. He saw first-hand, the regularity with which they denied claims and the vigor with which they defended those denials. This spurred him to start his firm, Doug Terry Law, which is committed to providing quality service to those whose insurance companies have unreasonably denied, underpaid, or delayed their claims. He provides them with the same high level of representation as the insurance companies receive from their attorneys.

Contact Us Immediately

For decades, Doug Terry and his team have been representing individuals in Oklahoma whose health insurance claims, including those for mental health services, have been denied.  Their understanding of the insurance company’s business goals is personal, and they know how to address them effectively.

We are all responsible for our own health, and steps to maintain it should be treated with respect; insurance companies must uphold the language in their policies and treat their customers in good faith.

If your mental healthcare claim has been denied or underpaid, reach out to us today at 405-463-6362.  We are well well-known for providing high-quality, compassionate, and successful service.