Hammond, Indiana Healthcare & Benefits Lawyers

What should I do if my health insurance claim is denied?

Request the denial in writing with the specific reason and the policy provisions relied on. You have the right to an internal appeal, which must be reviewed by someone who wasn't involved in the initial denial. If the internal appeal is denied, you may be entitled to an external review by an independent third party. Keep copies of everything. An attorney can help at any stage of this process.

What is ERISA and how does it affect my benefits?

ERISA (Employee Retirement Income Security Act) is a federal law that governs most employer-sponsored health, disability, and retirement plans. It sets minimum standards for how plans operate and provides a framework for disputes. ERISA preempts most state laws, which means your remedies may be more limited than under state insurance law. An attorney familiar with ERISA can navigate these complexities.

Can my insurance company deny coverage for a pre-existing condition?

Under the Affordable Care Act, most health insurance plans cannot deny coverage or charge more based on pre-existing conditions. However, some plan types (short-term plans, health sharing ministries) may not be subject to these rules. If you believe you've been improperly denied coverage based on a pre-existing condition, consult an attorney to evaluate your plan type and rights.

What are my rights if I receive a surprise medical bill?

The federal No Surprises Act protects patients from unexpected out-of-network bills for emergency services and certain non-emergency services at in-network facilities. Many states have additional surprise billing protections. If you receive a bill you believe is covered by these protections, dispute it with the provider and your insurer. An attorney can help if the dispute isn't resolved.

How do I appeal a disability insurance denial?

Review the denial letter carefully — it should explain why and what additional information might change the decision. For employer-sponsored plans under ERISA, you typically have 180 days to file an administrative appeal. This appeal is critical because the administrative record may be the only evidence a court can consider later. An attorney can help build the strongest possible appeal.

What is mental health parity?

Federal parity laws require most health plans to cover mental health and substance use disorder treatment at the same level as medical and surgical treatment. This means insurers cannot impose stricter limitations on mental health coverage — such as higher copays, lower visit limits, or more restrictive prior authorization requirements — than they apply to comparable physical health benefits.

Can I sue my health insurance company?

It depends on your plan type. For employer-sponsored ERISA plans, you must exhaust administrative appeals before filing a lawsuit, and remedies in court may be limited to the benefit owed (not punitive damages). For individual plans and non-ERISA plans, state laws may provide broader remedies including bad faith claims. An attorney can advise based on your specific plan and situation.

What if my insurance company delays my claim for months?

Insurance companies must process claims within timeframes set by law and regulation. Under ERISA, plans generally have 30 days for initial determinations and 60 days for appeals (with possible extensions). State laws may impose additional requirements. Unreasonable delays can be challenged through regulatory complaints or legal action. Document all communications and deadlines.