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100 Most Influential Lawyers in America
– the National Law Journal

Did your HMO or PPO deny your insurance claim?

On Behalf of | Oct 11, 2021 | Insurance & HMO Claim Denials

When an injury strikes, the world can come crashing down around the victim and his or her family members. In most cases, these people rely on their insurance to ensure that they receive proper treatment so that they can resume to their normal lives as soon as possible.

Unfortunately, despite all assurances that insurance companies provide, claiming insurance is not always easy, as many people in California and elsewhere may have already seen. In order to make things easier, many people rely on Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) but even then, the ride may not be smooth.

HMO and PPO claim denials

The purpose of creating HMOs was to reduce the cost of health care by managing the services that a patient requires when seeking medical treatment. However, the pressure of reducing costs often leads to the HMO denying a particular claim, which can sometimes even be a matter of life and death.

A PPO’s job is to process an injured person’s claim and pay for all medical treatment that was covered in the plan. For this, the PPO charges an annual premium. However, despite paying premiums on time, it is often seen that PPOs deny pre-approvals for treatment that have the potential to reduce pain or improve heath, and in some cases, save lives.

Dealing with claim denials

At Hiepler & Hiepler, we understand how challenging it can be when a loved one is injured. Owing to our years of experience in representing victims and families, we empathize with their situation and, therefore, we put in our best efforts to ensure that the victim gets what he or she rightfully deserves from the HMO or the PPO.

If you wish to learn more about our practice, feel free to visit our website. After all, it is one’s hard-earned money that is invested into HMO and PPO plans and when the facilities cannot be availed at the time of need, it can potentially be heartbreaking indeed.