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Insurance Denials/Bad Faith Information, News & Blogs

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Why Are Health Insurance Denial Cases So Complicated?

When a health insurance company denies a valid claim, it’s more than just a financial setback—it’s a betrayal of trust at a time when policyholders are most vulnerable. Unfortunately, pursuing legal action against an insurance company for a wrongful denial isn’t as simple as it may seem. Health insurance denial cases are legally and... Read More »

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What Is Evidence of Coverage?

If you’ve ever had a health insurance claim denied, the reason may have had something to do with a document called the Evidence of Coverage (EOC). While most people don’t pay much attention to this document when signing up for a health plan, it becomes critically important when a health insurer denies a service,... Read More »

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Health Insurance Claim Wrongfully Denied? Why You Need an Insurance Law Attorney and Not a Personal Injury Lawyer

If your health insurance claim has been denied in bad faith, you may be wondering what kind of legal help you need. Many people assume that a personal injury lawyer is the right choice, especially if they have been physically harmed by a claim denial or unreasonable delay. But bad faith insurance cases are... Read More »

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What Is a Medical Policy, and Why Is It Important When Your Insurance Claim Is Denied?

If you’ve had a health insurance claim denied, your insurer may have cited a “medical policy” as the reason. But what exactly is a medical policy, and how does it impact your ability to receive the treatment your doctor recommends? Understanding medical policies is crucial when challenging an insurance company’s denial of coverage, and... Read More »

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California Firefighters and Health Insurance Denials

Firefighters put their lives on the line every day to protect communities, often facing dangerous and physically demanding conditions. In return, they rely on employer-sponsored health insurance to cover medical expenses. However, when an insurance company wrongfully denies a claim, the consequences can be severe. Fortunately, California firefighters are generally exempt from the Employee... Read More »

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Archives

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How Public Employee Insurance Denials Are Different

When a health insurance company denies a claim, policyholders often assume they have the right to challenge the denial in court and seek compensation for any harm caused. However, the legal options available to policyholders depend largely on whether their insurance plan is governed by the Employee Retirement Income Security Act (ERISA). Most private-sector... Read More »

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Anthem is Processing and Handling Insurance Claims Offshore: What Does This Mean for You?

If you have health insurance through Anthem, you expect your claims to be processed fairly and promptly. However, recent reports reveal that Anthem has been outsourcing the handling of insurance claims to overseas contractors, raising serious concerns about delays, denials, and the overall quality of claim reviews. If your health insurance claim has been... Read More »

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A Busy January at the DMHC

California’s Health Care Regulator Starts the Year Off Right, Protecting Consumers and Holding Insurance Companies Accountable for Violating the Law The mission of the California Department of Managed Health Care (DMHC) is to protect the healthcare rights of Californians. Consumers can file complaints with the DMHC, and if the agency finds wrongdoing, it can... Read More »

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Anthem Blue Cross Visited With $95,000 in Penalties in January

Only one month into the new year, the California Department of Managed Health Care has already issued two enforcement actions against Blue Cross of California d.b.a. Anthem Blue Cross, penalizing the company $75,000 on January 14th and $20,000 on January 17th. The actions by the state regulator penalize Anthem for violating California law in... Read More »

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How AI Is Failing Insureds: The Dark Side of Automation in Health Insurance

Artificial intelligence (AI) has revolutionized industries worldwide, promising greater efficiency, cost savings, and improved decision-making. In the health insurance sector, insurers have embraced AI to automate claims processing, detect fraud, and assess risks. While these advancements sound promising, the reality for many insured individuals has been far less optimistic. AI is increasingly being used... Read More »

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