Luckily, if Aetna or any other insurance company has denied your health or disability claim, it isn’t the end of the road for your claims process. Unfair denials may lead to loss or foreclosure of your property, loss of income, loss of your savings, or the inability to access medical care. You failed to disclose a pre-existing health conditionĮven though you’ve been paying for your premiums every time they are due, you may end up being a victim of Aetna’s insurance denial practices, and this could mean losing the financial security you thought you could count on.The medical examinations were inadequate or insufficient.There were issues with documentation or paperwork.The policyholder failed to disclose a pre-existing condition.The policyholder misinterpreted something in their original application.Medical treatment or procedure is investigational or experimental.The claim filed was for a medical condition that isn’t authorized or covered.The treating physician is out of network or out of plan.The procedure is merely cosmetic and not medically necessary.If your health or disability benefits have been denied, Aetna may have claimed the following: These numbers show just how crucial it is for a policyholder to receive the coverage they need to offset such bills. In California, for instance, the cost for an individual to stay a single day in the hospital was closer to $3,725 at a non-profit hospital and $3,000 in a government hospital. The national average cost for a day’s stay in a hospital is somewhat above $2,000, according to a report by the Henry J. Health care costs have dramatically peaked over the years. Also, they often offer to cover only a partial reimbursement of a procedure or treatment. Aetna may refuse to pay for a treatment or procedure and instead suggest a lower cost course of treatment.

Even if they accept a claim, health insurers such as Aetna are notorious for offering lowball settlements on health insurance claims. Nonetheless, all too often Aetna delays and denies claims by citing seemingly mundane reasons, leaving policyholders with huge medical debts that they have to pay for out-of-pocket. For the insurance provider, it means they receive premiums from the insured. For the policyholder, this means they get the coverage guaranteed under their insurance policy. This means that neither the policyholder nor Aetna would do anything to injure the other party’s rights to receive benefits of the contract. For this reason, insurance providers such as Aetna are required by law to act in good faith and fair dealing. Health insurance and disability insurance policies are contracts between the insured and the insurance carrier. Overview of Aetna Insurance Denial and Delay We work with policyholders who thought they were protected only for their insurer to deny their claims. Contact us online today or at 31 for immediate help with your Aetna claim. If you submitted a claim for health or disability insurance coverage to Aetna and were denied or delayed benefits after an appeal or at the initial stage, Stop Insurance Denial Law Firm is here to help you. They bank on you not putting much of a fight when they delay benefits or ask you to settle a claim for less than it is really worth. Unfortunately, Aetna and other huge health insurance providers act in bad faith more often than you might think. Aetna knows that giving the insured an eternal runaround or out rightly denying claims can often increase their profits. And while this may appear like an obvious financial ability to pay valid claims, Aetna continues to delay and deny coverage. Aetna, for instance, collects more than 30 billion dollars in premium revenues in any one financial year. Health insurance companies such as Aetna win when they deny valid claims and the insured doesn’t fight back.

What to Do if Your Insurance Claim is Denied.

What to Do If Your Health Insurance Claim is Denied.Importance of an Insurance Denial Lawyer.Hiring a Health Insurance Denial Attorney.COVID-19 Business Interuption Insurance Denial.Health Insurance 101: What to Do After Your Claim is Denied.Disability Claims for Professionals and Executives.Experimental or Investigational Treatment Denials.

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