Two Blue Cross insurance plans were recently fined a total of $8.5 million by the California Department of Managed Health Care (DMHC) for failing to acknowledge and resolve provider disputes within the time frames required by law. These serious failures on the part of Blue Cross could ultimately harm patient care and are indicative... Read More »
In today’s rapidly evolving digital world, automation is becoming more prevalent across many industries, including insurance. Health and life insurance companies increasingly rely on automated systems to process claims. While this may seem like a step toward efficiency, the reality is that claim automation often works against policyholders; it can even result in the... Read More »
Health insurance is for everyone, and California law makes it clear that insurance companies are not allowed to impose exclusions, charge differentials, or other modifications of enrollee benefits based on race, color, national origin, ancestry, religion, sex, gender, marital status, sexual orientation, or age. One exception is that premiums, prices and charge differentials based... Read More »
For years now, insurance companies like Blue Cross of California d.b.a. Anthem Blue Cross have been made aware of the requirements under California to maintain a policy and procedure to receive and process customer complaints (grievances) and to respond to complaints and resolve them within the time frame specified in the law. Nevertheless, companies... Read More »
When a policyholder files a claim with their health or life insurance company, they expect a fair evaluation and a clear explanation if their claim is denied. Unfortunately, some insurers engage in practices that fall short of this expectation, including failing to promptly explain the reasons behind a denial. In California, this failure can... Read More »
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