Healthcare is expensive. Most of us cannot afford to pay for even routine medical procedures on our own, much less when the catastrophic happens. Many employers provide medical insurance as a critical benefit for their employees and their dependents. While you and your doctors know what is best for you, many times, insurers disagree. When insurers dispute the appropriateness or necessity of your personal medical care, it is not only frustrating and offensive, but it can be financially ruinous. Indeed, when insurers wrongfully deny covered medical expenses without justification, or by claiming that the procedure is not medically necessary, is preexisting, experimental, investigative, or elective, or by otherwise acting in violation of the terms of the insurance policy, their actions can have a disastrous financial impact on individuals and their families. Sometimes even the delay in approving necessary medical procedures can put your health and bank account at risk. We regularly challenge group and individual health benefit denials for clients seeking coverage for their medical claims and procedures.

We also regularly challenge group and individual health benefit denials and terminations for clients seeking coverage for behavioral health services or treatment, including outpatient and residential mental health treatment, as well as clients seeking coverage for substance-use disorders or addiction treatment. Unfortunately, health insurance companies will often deny coverage for such services or treatments for any number of reasons, including but not limited to, a finding that the requested care is not considered medically necessary, the availability of less intensive treatment or a lower level of care, or a determination that the mental health treatment or service is not in line with accepted medical practices. We have experience handling claims and appeals for individuals suffering from serious mental illnesses, including major depression, schizophrenia, bipolar disorder, eating disorders, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder (“PTSD”), borderline personality disorder, and others.

When such denials and terminations do take place, strict deadlines and procedural rules govern your ability to challenge to the insurer’s decision. We have significant experience successfully handling claims and appeals, as well as litigating when necessary in all state and federal trial and appellate courts, against most major medical insurers, including Aetna, Anthem, BlueCross BlueShield, Cigna, Highmark, Humana, IHC, Kaiser, Optum, United Behavioral Health, United Health, Wellpoint, and most other major health administrators, providers, and carriers.

While we are physically located in Charlotte, we regularly represent individuals throughout the entire state of North Carolina. For additional information or to determine if you need assistance with a claim, please complete the form below or give us a call at (704) 377-4300.