The California Department of Managed Health Care (DMHC) exists to protect consumers by regulating health care service plans and enforcing some of the nation’s strongest health insurance laws. The agency oversees most HMOs and many PPOs in California, as well as the majority of Medi-Cal managed care plans. In total, approximately 236 health plans,... Read More »
Bringing a new child into the world should be a time of celebration, not a battle with a health insurance company over whether a newborn’s medical care will be covered. Yet that is exactly what happened in two cases that recently resulted in enforcement action by the California Department of Managed Health Care (DMHC).... Read More »
Health insurance companies often describe claim denials as the result of objective medical reviews and careful application of policy language. In reality, many policyholders discover that obtaining coverage for medically necessary treatment can become a lengthy battle involving shifting explanations, administrative roadblocks, and repeated requests for additional information. Not every denial is improper. Health... Read More »
Gianelli & Morris represents California policyholders whose health insurance claims have been delayed, denied, or effectively obstructed through access barriers imposed by health plans. One of the most frustrating and serious problems facing insured patients today is not outright denial of coverage, but the inability to actually obtain timely medical appointments with a specialist.... Read More »
The Department of Managed Health Care (DMHC) regulates health plans in California, working to ensure that health plan members have access to timely, affordable and high-quality health care. This job includes investigating complaints of wrongful claim denials and taking action against health insurers in the form of administrative penalties and other corrective actions designed... Read More »
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