If you believe the government website, Healthcare.gov, when it says, “Health insurance provides financial protection in case you have a serious accident or illness,” and then reiterates the idea a little later in the same paragraph – “Health coverage can help protect you from high, unexpected costs,” you may find it inappropriate that an insurance company would go to great lengths to deny your health insurance claim. But that is exactly what happens not only in Edmonds, OK, but all over the country. Even though insurance companies are mandated to act in good faith when considering policyholders’ health insurance claims, they flaunt this responsibility and deny or underpay claims every day. What is more disturbing, the tactics they use are shocking.
Insurance is Big Business
If you’re wondering why you’re not getting the coverage you thought you paid for, the truth of the matter is that insurance companies are businesses. And as such, their end all is to make a profit. So while you may have thought your insurance company would look after your best interests, the sad truth is it will always act in its own best interests. And so, they train a team of amiable employees to serve as guard dogs with friendly voices. But don’t let that soothing voice you hear on the phone make you too comfortable. There is a limit to the help he or she offers. Like many guard dogs, he’s on a short leash. In case you haven’t surmised, we’re talking about the insurance adjuster.
The Insurance Adjuster
Although it may appear that the seemingly sympathetic insurance adjuster assigned to your claim is there to help you get fair compensation, in actuality, she has been trained to appear to be on your side while actually employing sleight of hand tactics so that her employer, the insurance company comes out on top. Don’t expect her to go out of her way to plead your case nor to make sure you understand the extent of the actual costs involved. After all, she owes her job to find ways to justify reductions in the coverage you were expecting or deny your claim altogether.
So rather than trusting her to have your back, make sure she answers all your questions, and to be on the safe side, talk to an attorney who specializes in insurance denial claims. And beware if you spot any signs of the following deceptive tactics.
The Big Rush
If you have suffered a head or back injury, the lasting effects will not be known for weeks, months, or even years. Witness Chronic Traumatic Encephalopathy (CTE), the permanent degenerative disability discovered in football players long after they have given up the game. Knowing full well that if you have suffered a fall or in some other way hurt your back or head, the true extent of the trauma may take years to present itself, your insurer will want to push you to accept an amount they represent as fair and adequate. However, they really want to settle your claim as soon as possible, shutting down your chances of getting compensation that is genuinely fair and adequate should your injury reveal severe effects down the line.
The Big Delay
At the opposite end of the spectrum, you may find that an insurance adjuster is unbelievably prompt in responding to your claim. However, once you have given him the details, the company will come up with all sorts of excuses for delaying further action and taking steps toward closing your case and sending out payments. Why? Because they know your situation is draining you emotionally, your anxiety builds ever higher with each medical bill that comes in. They do not deny your claim, but they are banking that if they keep you waiting, you’ll become so desperate that you’ll accept any low and inadequate amount they offer.
Recording Your Voice
“This call may be recorded for training purposes.” It’s a warning you’ve heard so often it’s expected whenever you make a customer service call. But when you hear the word record, anytime, you call your insurance company. It’s more than rhetoric. It’s a tactic to capture words they can use against your claim later on.
In your effort to make sure you notify your insurance company of an injury you’ve incurred, you may be speaking before your doctor has had sufficient time to discover the extent of your injuries and determine if there will be lasting effects. While you want to cross all your t’s and dot all your i’s, in essence, you may be devaluing your own claim. If you’ve consented to a recording, and your injuries turn out to be more than you’ve described, your words may be used as evidence that you’re beefing up your claim, and it may very well be denied. So if an adjuster ever asks you for permission to record your statement – just say no.
Peering into Your Past
It’s not uncommon for an insurance company to ask you to sign forms, but if one of the forms is permission to release your medical records, it’s a red flag that they may be looking for information to use against you. Once you say yes, the insurer will have access to reports written by any physician or specialist who has ever examined you. And since the claims adjuster has been trained to tilt the odds in favor of the insurance company that employs him, you can bet that should he come upon any previous illness or injury you’ve ever been treated for, no matter how long ago, he will do his best to represent it as a pre-existing condition that is aggravating or even causing it. So always read any form that’s put in front of you, and if it’s a release of medical records, just say no.
These are a few of the tactics insurance companies use to deny health insurance claims. So if there’s one thing you take away from this article, it’s that while insurance companies are liable by law to compensate you for any long or short-term loss or harm you suffer as a result of illness or injury, their focus is always on the bottom line. And so, the adjusters they employ are in no way bound to make clear the extent of the expenses you will face or to plead your case for you. That’s your job, and it will go a lot smoother if you have insurance denial attorney Doug Terry by your side.