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Medical Necessity and Dental Procedures

Anyone who has had a serious dental problem knows that oral health can absolutely affect your overall health. If you don’t have dental insurance, a dental or orthodontic procedure can be prohibitively expensive. Under certain circumstances, however, you may be able to get your dental procedures covered under your general health insurance plan. If... Read More »

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Anthem’s Policy on Avoidable ER Visits: A Closer Look

Anthem is one of the leading providers of health insurance in California and the second-largest insurer in the country. Like many large insurance companies, Anthem has a history of using shady tactics to avoid paying out on claims that should rightfully be covered. In addition to blanket policies denying coverage for debilitating conditions by... Read More »

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What to Do if Health Net Denies Chemotherapy Claim

A cancer diagnosis is terrible, but in the modern era, it is not necessarily a death sentence. Cancer treatments have advanced radically in the past few decades. Treatments such as chemotherapy are, unfortunately, extremely expensive. Several years of treatment can bankrupt a family if their insurance does not cover the procedures. Insurance providers that... Read More »

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Insurance Companies Can Get Fined For Ignoring Claims

Insurance providers are required by law to investigate and respond to claims within a reasonable period of time. Failing to conduct a proper investigation or make a finding on a claim within a reasonable time can open insurance providers up to liability for bad faith practices. Additionally, insurance companies are required to respond to... Read More »

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For Doctors: Disability Insurance & Life Insurance Through COVID-19

Physicians and other healthcare workers are directly exposed to the novel coronavirus on a daily basis. At many points throughout the pandemic, they have been left without adequate personal protective equipment (PPE) or clear guidelines on how to isolate, treat, and avoid infection from active coronavirus patients. Doctors, like people in other professions, are... Read More »

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Why Disability Insurance Companies Deny Benefits to Medical Professionals

Medical professionals often face unique challenges when seeking long-term disability (LTD) benefits. Medical professionals often have high salaries and benefits, which means that insurance payouts would be larger than for members of other professions. As a result, claims adjusters are likely to be even more stringent when evaluating disability claims from physicians and other... Read More »

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Doctors With Long-Term Disability Policies Face Extra Scrutiny From Insurance Companies

Disability insurance protects medical professionals in the event that injury or illness prevents them from continuing in their profession. Insurance companies, however, do not favor doctors over any professionals; if they can find a reason to deny long-term disability (LTD) or short-term disability (STD) benefits to physicians in order to protect their profit margin,... Read More »

Everybody Wins: Gianelli & Morris says its insurance class actions help both sides

LOS ANGELES & SAN FRANCISCO Daily Journal MONDAY, FEBRUARY 22, 2021 By Shane Nelson Special to the Daily Journal Timothy J. Morris first encountered his long-time legal partner Rob­ert S. Gianelli on a Pop Warner football field when the two were 10. “I was the quarterback for the Reseda Rams, and Rob was, I... Read More »

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How Disability is Defined for Physicians With Long-Term Disability Policies

Disability insurance is meant to protect a policyholder who, due to illness or injury, is no longer able to work. Long-term disability (LTD) means the claimant will be unable to work for a significant period of time–typically two years, five years, or even until retirement, depending on the policy. How the policy defines “disability”... Read More »

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Gianelli & Morris Helps Client Overcome “Lack of Medical Necessity” Insurance Denial

Recently on this blog, we discussed one of the principal reasons given by health insurance providers in denying claims: lack of medical necessity. Insurance providers sometimes reject a claim as medically unnecessary even when the treating physician recommends the treatment to deal with a given illness or injury. Insurers try to shield themselves by... Read More »

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