Stuart D. Morse & Associates, L.L.C

Stuart D. Morse & Associates, L.L.C
Stuart D. Morse & Associates, L.L.C
Colorado Insurance Defense And Business Litigation Attorneys

CALL US TOLL FREE 866-825-5850

Taking a balanced look at hospital insurance claim denials

On Behalf of | Jul 7, 2017 | Insurance Defense |

From the perspective of many reputable insurance companies in Colorado and nationally that routinely seek to timely and fully hold up their end of the bargain regarding an insured’s claim, it sometimes seems that they face an extra-contractual challenge when responding to a payment demand.

And that is this: simultaneously dealing with the perception that they are somehow responding in outright bad faith or at least in a manner that undercuts an insured’s best interests in favor of the company’s bottom line.

Insurers deal with that mindset every day. Of course, and in keeping with every American industry, there are episodes of wrongdoing alleged and sometimes proven concerning select companies and policies, but that is far from the norm. If it wasn’t, the insurance industry would be materially short lived.

The sheer size and scope of insurance offerings across the United States manifestly underscores the perceptions of millions of policyholders that insurance coverage is a dire necessity and proven resource across many dimensions.

As we flatly note on our insurance defense website at the experienced Colorado law firm of Stuart D. Morse & Associates, L.L.C., “Insurance exists to protect us financially.”

That is certainly true in the medical realm, where hospitals and other providers daily submit payment claims totaling millions of dollars.

Not all of those are quickly or routinely paid, of course. And when they aren’t, insurers are once again vulnerable to claims of negligence or purposeful nonperformance.

Consider this, though, as explicitly noted in a recent health-related article focused upon insurers’ denial of hospital claims: Many of those claims clearly relate to insurance companies’ valid concerns based upon incomplete or inaccurate information, questionable services, lack of authorization and more.

Commentators on insurers’ treatment of claims often adopt a negative stance. A truly accurate and balanced appraisal of insurance claim delays or denials must also — and necessarily — present an objective picture concerning the many legitimate reasons that might hold up a claim or otherwise yield material concerns regarding its payment.