I met my deductible, but the insurance company still won’t pay.
I met my deductible, but the insurance company still won't pay.
Insurance can be a complicated thing to try to understand. There are many insurance companies and plans and now with the Affordable Healthcare Act, there are even more things to consider. Deductibles, premiums, copayments, and coinsurance are all significant things you must consider when selecting a health insurance provider and plan. What exactly is a deductible? When are you supposed to pay and when is your insurance provider supposed to pay?
What is a deductible?
Your insurance deductible is the amount of money you owe for health care services covered by your health insurance plan before your health insurance or plan starts paying. As an example, if your deductible is $1,000, your health insurance company won’t contribute any money until you’ve paid $1,000 (met your deductible) for covered health care services, which are subject to the deductible.
When does the insurance company pay?
Since medical billing is run through your insurance company first, your insurance company will bill you according to the details of your policy. So, if your policy requires a deductible for certain services, it will pass the bill on to you to pay if something comes from your health care provider and you have not yet met the deductible. Once you have met the deductible, the insurance company should pay your health care provider directly for the services and send you some kind of notification informing you they have paid for services and you owe nothing.
What if the insurance won’t pay once you’ve met your deductible?
If your insurance company is refusing to pay for your health care services even though you’ve met your deductible, it’s imperative you find out why. Is there a loophole in your policy that indicates your insurance company doesn’t have to pay? Are you clear on the stipulations and provisions of your policy and what they should be covering? Hopefully they are not denying payment illegally, but it’s possible they are. If the insurance company is refusing to cover the costs of your health care services, which they should be paying according to the details of your policy, you should contact an experienced attorney who deals with denied insurance claims immediately.
For experienced guidance through your insurance claim concerns, contact our Oklahoma City denied insurance claim law firm at 405-235-4500 to schedule a free initial consultation.