Health Insurance Claims

Health plans frequently deny claims for treatment of various health conditions. The denials are often based on a policy provision that requires treatment to be “medically necessary” or because a type of treatment is “experimental.” Health plans come up with a variety of other reasons to reject the coverage people need despite receiving premiums year in and year out.

Gianelli & Morris has been successful in recovering clients’ health benefits. Gianelli & Morris has successfully pursued claims against Kaiser, Anthem Blue Cross, Blue Shield, and Health Net.

Sometimes these cases are brought as class actions where one or more persons files a lawsuit on behalf of the hundreds or thousands of other persons who have had their claims denied in the same way. One such case was Arce v. Kaiser Foundation Health Plan, Inc., Los Angeles Superior Court Case No. BC 388689 where partner Robert S. Gianelli successfully prosecuted a class action against Kaiser for its refusal to provide treatment to thousands of autistic children. Mr. Gianelli’s work in that case earned him a California Lawyer magazine’s 2015 Attorney of the Year (CLAY) award in the category of Disability Rights.

Gianelli & Morris has brought successful cases against health plans for denying coverage for treatment of a variety of health conditions, including cancer, heart disease, back problems including the use of artificial disks, disfiguring excess skin, neurological problems, mental health care, and other conditions.