Insurance Denials/Bad Faith Information, News & Blogs
Failing to Explain a Denial
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 »
Anthem Fined $30,000 for Failing to Provide DMHC With Information Used to Resolve Grievances
Not only does Anthem consistently fail to respond to customer complaints in a timely manner if at all, they don’t even respond well to requests from the California state insurance regulator. The regulator, the Department of Managed Health Care (DMHC), has the authority to assess administrative penalties, but it seems even slapping the company… Read More »
Anthem’s Rocky Road With California’s Insurance Regulator Regarding the Insurance Company’s Defective Grievance System
The California Department of Managed Health Care (DMHC) is a government agency regulating managed health care plans in the state, including health maintenance organizations (HMOs) and most of the managed care plans servicing Medi-Cal recipients, such as Anthem Blue Cross, Health Net, Blue Shield Promise, Molina, and others. Every covered health plan is required… Read More »
Life Insurance Payments and Proceeds Under California Law
Life insurance meets critical needs for individuals and families, providing valuable financial assistance just when they need it most. Unfortunately, insurance companies might not always have your best interests at heart. Instead, they might look to maximize profits and protect their bottom line by finding ways to delay or deny the payment of proceeds… Read More »
New California Law Could Speed up Timeframe for Insurance Companies to Authorize Procedures
If you’ve ever had to get prior authorization from your health plan before having a procedure done, you know firsthand the stress and anxiety that comes with waiting around for the insurance company to make a decision on your case, hoping the authorization comes through and in a timely manner. As introduced, Assembly Bill… Read More »
ProPublica Says Health Insurers Don’t Always Follow the Law After Denying a Claim
As an insurance law firm that regularly gets contacted by Californians who had an insurance claim denied and are frustrated with their inability to get the insurance company to listen to them, it comes as no surprise to us to hear that insurers don’t always follow the law when denying a claim or in… Read More »
How to Prove Insurance Bad Faith
Insurance is a safety net designed to protect us when unforeseen events occur. Whether it’s health, life, or disability insurance, policyholders rely on their coverage to provide financial support during difficult times. Unfortunately, insurance companies sometimes deny claims unjustly, engaging in what is known as “bad faith” practices. At Gianelli & Morris, we understand… Read More »
Blue Shield of California Terminates Executive Over Alleged Credential Fraud
Blue Shield of California announced that it has involuntarily terminated Tosha Lara-Larios, one of its interim medical directors, after discovering she allegedly misrepresented her qualifications. The health insurance company reported the matter to law enforcement and is cooperating fully with the ongoing investigation, according to an article reported in the San Diego Union-Tribune on… Read More »
No Suprises Act Stops Balance Billing From Out-of-Network Providers of Emergency Care
Say you go to a doctor or hospital that you know is in your insurance network. You pay your deductible and/or co-pay and expect the rest will be covered by insurance. Weeks or months later, you get an unexpected bill in the mail. While the office or facility you visited was in-network, one or… Read More »
What if the Insurance Company Says Your ER Visit Wasn’t an Emergency?
Insurance companies don’t like ER visits because they are much more expensive than a scheduled doctor visit or even a trip to urgent care. Regardless, emergency departments exist for a reason. People do have medical emergencies, and emergency room physicians are specially trained in emergency medicine to deal with any kind of emergency, including… Read More »
