News & Articles
Department of Managed Health Care Report Exposes Bad Faith Denials among California Health Insurance Providers
The California Department of Managed Health Care (DMHC) is the regulatory office charged with overseeing the majority of health insurance coverage in the state. Health insurance policyholders can report disputes with their insurance provider to the DMHC, which will investigate those complaints, conduct independent medical reviews of denied claims, and carry out enforcement actions… Read More »
Insurers Deny Coverage for Excess Skin Removal Following Bariatric Surgery
As we have discussed time and again, insurers are always looking for reasons to deny coverage. Particularly where a procedure could possibly be defined as “cosmetic,” insurers will refuse coverage if they can find any justification to do so. But even so-called cosmetic issues can be disabling and disfiguring, and California law does not… Read More »
What is Insurance Bad Faith, and What can You do about It?
Insurance policyholders who are current on premiums and follow the rules have a legal right to receive coverage for claims included under the terms of their policy. If health insurers fail to provide payment for these covered claims, they’re not only breaching their contract and breaking the law, they’re potentially putting their policyholder’s life… Read More »
Insurance Companies Are Denying Coverage For Lipedema Treatments
Lipedema is a very common yet serious, painful, and crippling condition that affects nearly 11% of adult women worldwide. There are known treatments for lipedema, but insurance companies have taken strong stances against covering the cost of these cures for their paying policyholders. The dedicated and compassionate Los Angeles insurance bad faith attorneys at… Read More »
Gianelli & Morris Sues Anthem, Inc. over Denial of Insurance Coverage for Lipedema
On January 17, 2019, Gianelli & Morris, a Los Angeles insurance bad faith law firm, filed a complaint against Anthem, Inc. and its utilization management arm Anthem UM on behalf of Robin Goolsby, a patient diagnosed with Stage 3 advanced lipedema whose request for coverage for tumescent liposuction was denied. Anthem UM’s denial letter… Read More »
Insurance Denial of Reconstructive Surgery
Too often, reconstructive surgery is denied for insurance reimbursement because insurance companies deem the surgery cosmetic and not medically necessary. The insurance companies assert that a medical necessity requires the illness to cause a functional, medical impairment for the patient, and insurance benefits are not available for a procedure done primarily to improve appearance…. Read More »
Appealing the Denial of an Insurance Claim
Appealing denied insurance claims requires an insured to go through the internal appeals process. When your insurance claim is denied by your provider, be it disability, health, property, life, etc., you have several options. The law entitles you to challenge the denial via one of a number of processes. Your insurance plan will typically… Read More »
Top Signs Your Insurance Denial was in Bad Faith
Insurance companies have a duty to act in “good faith” when responding to policyholder claims. However, we have all heard stories of insurance companies denying claims that seem otherwise legitimate. Insurance companies are private businesses, and first and foremost they care about their profits. Sometimes insurers treat their policyholders less than fairly to protect… Read More »
Attorney Gianelli Files Complaint Against Anthem Blue Cross of California
Attorney Robert Gianelli filed a complaint in the Superior Court of Los Angeles on September 14th, 2018, alleging that Blue Cross of California (doing business as Anthem Blue Cross) wrongfully denied benefits and acted in bad faith towards a client. The suit alleges that Blue Cross of California denied treatment for his client’s stage… Read More »
Fighting a Health Plan’s “Investigational” Denial of a Medical Claim
Health plan contracts typically have exclusions for treatments that an insurance company considers “investigational” or “experimental.” Health plans say there is insufficient proof demonstrating that certain treatments are safe and effective for their intended use, making them investigational or experimental and not a covered medical benefit. Whether a particular treatment is investigational or experimental… Read More »
