How to Choose the Right Attorney for a Health Insurance Denial Case

What makes the field of health and medicine law different from other areas of legal practice?

Health and medicine law is uniquely complex because it involves the interplay of multiple legal layers — administrative law, state law, and federal law. An attorney practicing in this area needs deep knowledge of the nuances of each, as every health insurance case can present entirely different legal scenarios. It’s not as straightforward as other insurance matters; extensive groundwork and a careful preliminary review are often needed just to determine if legal action is possible. The type of health insurance plan, the regulatory framework, and the nature of the denial all play critical roles, and only a lawyer experienced in this space can navigate them effectively.

Why did Maria T. Santi choose to specialize in health law?

Maria’s path into health law was shaped by her lifelong passion for medicine, science, and helping people. She originally dreamed of being a pediatrician, but after life changes, she became a psychology major and later pursued law. When she discovered her law school offered a health law concentration, it felt like the perfect way to blend her love of medicine with her legal skills. Throughout her life, friends and family often turned to her for help with insurance and medical bill issues. Personal experiences — like fighting for her son and grandmother’s insurance coverage — strengthened her sense of purpose. One particularly meaningful case involved securing a $2 million life-saving medication for a child, something that even her doctors couldn’t achieve. These moments confirmed for Maria that this was her mission: to help patients secure the care they deserve.

Does having a background in psychology help in handling insurance cases?

Yes, Maria’s background in psychology provides a valuable edge, especially when understanding the mindset and tactics of insurance companies. Psychology involves rigorous training in statistics, research methods, and critical evaluation of studies — all of which are useful when reviewing insurance coverage guidelines, interpreting medical journal citations, or analyzing data used to justify a denial. This foundation helps Maria identify when insurance data or conclusions might be skewed, ensuring she doesn’t just accept surface-level justifications but digs deeper into the validity and reliability of the information behind a denial.

What questions should you ask when interviewing a lawyer for a health insurance denial case?

Start with the basics: What is the lawyer’s experience? What’s their background, and do they specialize in health law? But beyond that, focus on how the attorney approaches your case. Are they asking thoughtful, detailed questions about your situation? A good lawyer will want to gather as much information as possible before committing to your case. Be cautious of any lawyer who quickly signs you up without understanding the details — that’s a red flag. You want an attorney who is selective, meticulous, and genuinely invested in assessing whether you have a strong legal basis to move forward.

What are red flags when selecting an attorney for a denial case?

Some key warning signs include attorneys who don’t ask questions, rush to sign clients without assessing the case, or seem overly focused on upfront payments. In many health insurance denial cases, it’s possible to work on a contingency basis, meaning the patient doesn’t pay unless the case succeeds. Also, watch out for attorneys who don’t specialize in this area but take on any type of legal work. Health and medicine law is a highly specialized field, and working with someone lacking that focus can weaken your chances of success.

How important is compassion and empathy in health insurance denial cases?

Compassion and empathy are essential in this area of law. Many patients are seeking coverage for life-saving treatments, and the emotional weight is enormous. It’s not just about legal strategy — it’s about truly listening, understanding what the patient and their family are going through, and recognizing that you might be their last hope. A successful attorney in this space needs to be sensitive, attentive, and committed to helping clients navigate these overwhelming challenges. Even when the case is about recovering money after treatment, the financial strain on families can be devastating, requiring a lawyer who understands the personal impact, not just the legal one.

How do medical bills affect patients financially, and are there any recent legal changes?

Medical debt is one of the leading causes of debt and bankruptcy in the U.S. Many patients face crushing financial burdens simply from trying to afford the care they need. While there have been some recent legal changes to how medical debt is reported to credit bureaus — potentially reducing the negative impact on credit scores — these rules are still evolving and not yet fully finalized. Nevertheless, medical debt remains a massive issue for countless families, underscoring the importance of fighting wrongful denials.

What is the most important thing patients should know when fighting a health insurance denial?

Patients need to understand that insurance companies often operate using checklists based on their coverage guidelines. Many people don’t realize that they have the right to access these guidelines — they’re often available online or by request. Reviewing these can reveal whether the insurance company is applying its own criteria correctly. Sometimes, patients actually meet the required criteria, but the insurance company either overlooks or misapplies them. Knowing about these internal guidelines can be a powerful first step in challenging a denial effectively.

Do most patients realize they can fight an insurance denial?

Unfortunately, many patients come to a lawyer only after feeling beaten down and exhausted by the process. They see legal help as a last resort, not realizing earlier that they could challenge a denial. By the time they reach an attorney, they’ve often faced multiple rejections and are desperate for help. This highlights why raising awareness is so crucial — patients need to know they have options and that there are legal avenues available before they reach the breaking point.

If you need expert legal help with a health insurance denial, connect with Maria T. Santi and the team at the Health and Medicine Law Firm by visiting healthandmedicinelawfirm.com.