Articles Posted in Eating Disorder Claims

Trumpcare, the Republicans’ proposed plan to replace the Affordable Care Act (ACA) — also known as “Obamacare” — will cut mental health and addiction treatment for 1.3 million people, just as the country is struggling to cope with an epidemic of opiate addiction. The Washington Post reported on March 9, 2017, that House Republicans admitted under questioning by Rep. Joe Kennedy III (D-MA) that their ACA repeal-and-replace plan would remove a requirement to offer substance abuse and mental-health coverage that’s now used by at least 1.3 million Americans.

Substance abuse and mental-health services are among the “essential benefits” states are required to provide under the ACA’s expansion of Medicaid, a program that provides health-care coverage to those who cannot afford it. As the article explained, if states opt out of providing those benefits, Medicaid recipients would not only lose coverage for mental-health care, but also coverage for care aimed at addressing substance abuse treatment, a critical area of care given the current drug overdose epidemic many states are dealing with. According to estimates by health-care economists, about 1.3 million Americans’ sole access to these services is through the ACA.

 

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As health care litigators, we are often asked about the benefits of the Affordable Care Act (“ACA” aka Obamacare). The bottom line is that more people have received more comprehensive coverage through the Affordable Care Act because of the following measures:

  1. No preexisting exclusion. Health plans can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer. https://www.hhs.gov/healthcare/about-the-law/pre-existing-conditions/index.html
  2. Young adults can remain as dependents on their parents’ health plans until age 26. Young people generally do not have access to sufficient individual health plans and do not have careers that provide the opportunity for an employer based plan so the opportunity to remain on a parent’s health plan is a great benefit. http://www.forbes.com/sites/emilywillingham/2017/01/25/have-a-teenager-you-should-worry-about-aca-repeal/#4a89ca150604

Insurance denial, ERISA denial, claim denied
Every insurance policy requires that you give notice of your claim for benefits to the company before benefits can be paid.  It doesn’t matter if the claim is for medical services, disability benefits, life insurance, fire, flood, theft, etc. Obviously, notice and information about your claim is necessary before the insurance conpany can process and pay the claim. Policies also usually require that notice of a claim be given within a specified time period following the loss, for example, “30 days,” or “as soon as practicable,” or “as soon as reasonably possible,” etc.  Again, this is fair because evidence related to the claim is fresh, and most readily available nearer the time of the event.

But, what happens if you can’t, or don’t comply with the policy notice requirement?  What happens if don’t give notice until months, or even years after your claim accrued?

Good questions.

Eating disorders are a serious public health concern in the United States and around the world. At least 30 million people in the United States will suffer from an eating disorder at some point in their life. And eating disorders don’t just impact women.  Approximately 10 million men in the United States will face an eating disorder in their lifetime. But despite the staggering number of people affected and the reality that eating disorders have the highest mortality rate of any mental illness, eating disorders often live in the shadows and most people don’t get the help they deserve. Unfortunately, all too often people will not seek out treatment due to stigma, misperceptions, lack of education, diagnosis and access to care.

Anorexia nervosa, bulimia nervosa and binge eating disorder are the most prevalent eating disorders. These eating disorders and all other eating disorders will be in the spotlight from February 26th, 2017 – March 4th, 2017 when patients, families, practitioners, advocates and educators celebrate National Eating Disorders Awareness Week. This year’s theme is “It’s Time to Talk About It” and the goal is for more people to get screened and start getting the help they need.

From the famed Empire State Building in the east, to Los Angeles International Airport’s stylish, 100-foot, glass pylons in the west, 61 iconic landmarks in cities across the country will be lit in the signature blue and green colors of the National Eating Disorders Association (NEDA) to put a spotlight on the seriousness of eating disorders.

On January 13, 2017, the Los Angeles Times published a column entitled Healthcare insurance hell: If at first your claim is denied, try, try again

The article describes on insured’s extreme difficulty in obtaining approval for treatments of her multiple autoimmune disorders that cause chronic pain, migraines, extreme dizziness and debilitating chronic fatigue. As the title shows, the main thrust of the argument is to never give up if your health insurance claim is denied – however, this advice is not only applicable to health insurance claims – the same holds true, believe it or not, for Long Term Disability, Long Term Care, and even Life Insurance claims!  

Some interesting additional information is also included in the column:

Kantor and Kantor LLP was nominated and has now been awarded the 2015 Best of Business Award for the Small Business category.

The Small Business Community Association has been dedicated to empowering and recognizing small business owners who make a difference in their respective communities since 2006.

We are honored to accept this award and grateful that our firm is recognized in this way.

Kantor & Kantor is honored to announce the selection of four attorneys from the firm for the 2015 Southern California Super Lawyers list. Inclusion in this list is reserved for attorneys who exhibit distinct excellence in their practice.

Super Lawyers, a prominent attorney rating service, identifies exceptional lawyers from more than 70 practice areas. The selected attorneys have attained substantial peer recognition and widespread professional achievement. The extensive and multiphase process used to determine 2014 California Super Lawyers relies on peer nominations, evaluations, and independent research.

All four lawyers were selected for their successes in representing people denied disability – particularly those with disabling conditions such as eating disorders, autoimmune diseases, Alzheimer’s, Parkinson’s, Multiple Sclerosis, cancer and mental illness – as well as assisting people recover benefits under long-term care, health and life insurance policies. This recognition and honor demonstrates the talent, dedication, and diligence of these attorneys; all of which they utilize to obtain the insurance benefits to which their clients are entitled.

Congratulations to Kantor and Kantor LLP who won the Small Business Community Association 2015 Best of Business Award for the Small Business category.

We are honored to have our work recognized in this way. Our attorneys and support staff work tirelessly to help those in our community get the benefits paid to which they are entitled. Medical Insurance, Disability Insurance, Long-term Care Insurance and Life Insurance are paramount to the health and longevity of those in our community. When Insurance companies fail to honor their contractual obligations to pay benefits under these policies, it is a detriment to our community.

We are grateful that our clients trust us and know that we get their benefits paid so they can continue to live healthy, fulfilling lives.

From time-to-time we review a health insurance policy for a client who has been denied medical treatment, services, or benefits and we find that their policy contains a binding arbitration provision. Oftentimes our clients are surprised to hear this and need help understanding what this means for them and their case.

Arbitration is an out-of-court proceeding in which a neutral third party, called an arbitrator, hears evidence and then makes a binding decision. Arbitration is the most commonly used method of Alternative Dispute Resolution. Indeed, if you look closely enough, you may find an arbitration clause in the fine print of all kinds of contracts these days.

As an alternative to judges or courts settling disputes between consumers and businesses, binding arbitration works out a deal through an independent, third-party – the arbitrator. Binding arbitration may save time, money, and energy when two parties disagree over a contract, the performance of a service, or the exchange of goods. The arbitrator’s decision is final and cannot be disputed or appealed.

While we certainly do not recommend it, you may choose to handle your own short term disability or long term disability claim.

If you decide to make a disability claim on your own, there are at least three things you should keep in mind when dealing with an insurance company.

1. Insurance Companies are For-Profit businesses.

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