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Insurance Denials/Bad Faith Information, News & Blogs

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ProPublica Says Health Insurers Don’t Always Follow the Law After Denying a Claim

As an insurance law firm that regularly gets contacted by Californians who had an insurance claim denied and are frustrated with their inability to get the insurance company to listen to them, it comes as no surprise to us to hear that insurers don’t always follow the law when denying a claim or in... Read More »

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How to Prove Insurance Bad Faith

Insurance is a safety net designed to protect us when unforeseen events occur. Whether it’s health, life, or disability insurance, policyholders rely on their coverage to provide financial support during difficult times. Unfortunately, insurance companies sometimes deny claims unjustly, engaging in what is known as “bad faith” practices. At Gianelli & Morris, we understand... Read More »

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Blue Shield of California Terminates Executive Over Alleged Credential Fraud

Blue Shield of California announced that it has involuntarily terminated Tosha Lara-Larios, one of its interim medical directors, after discovering she allegedly misrepresented her qualifications. The health insurance company reported the matter to law enforcement and is cooperating fully with the ongoing investigation, according to an article reported in the San Diego Union-Tribune on... Read More »

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No Suprises Act Stops Balance Billing From Out-of-Network Providers of Emergency Care

Say you go to a doctor or hospital that you know is in your insurance network. You pay your deductible and/or co-pay and expect the rest will be covered by insurance. Weeks or months later, you get an unexpected bill in the mail. While the office or facility you visited was in-network, one or... Read More »

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What if the Insurance Company Says Your ER Visit Wasn’t an Emergency?

Insurance companies don’t like ER visits because they are much more expensive than a scheduled doctor visit or even a trip to urgent care. Regardless, emergency departments exist for a reason. People do have medical emergencies, and emergency room physicians are specially trained in emergency medicine to deal with any kind of emergency, including... Read More »

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Crisci v. Security Insurance Company

Despite California’s existence as a state since 1850, bad faith insurance law was still being laid down in the courts as late as the 1960s and 70s and continues to be shaped today. Let’s take a look back at one of the landmark bad faith insurance cases in the state, with a ruling by... Read More »

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The True Cost of Health Insurance Claim Denials

How Denials Can Put You in the Poor House, Worsen Your Health, or Both KFF Health News is a leading source of media coverage on healthcare policy. KFF was formerly known as Kaiser Family Foundation, but it changed its name to avoid being confused with the HMO giant Kaiser Permanente, with which it is... Read More »

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California Expands Medi-Cal Coverage Yet Again

Leading the Nation in Serving the Health Care Needs of Low-Income Families and Undocumented Residents Starting on January 1 this year, California became the first state in the nation to ensure that all low-income residents qualify for Medi-Cal, the state’s version of Medicaid. The expansion includes undocumented immigrants who are otherwise eligible for Medi-Cal... Read More »

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Thirteen Anthem Plan Deficiencies Remain Uncorrected Four Years Later

California’s Department of Managed Health Care (DMHC) routinely surveys health plans in the state to ensure they are complying with the law. Outside of its routine, whenever DMHC has good cause to investigate issues of compliance with the law, it initiates an investigatory survey known as a non-routine survey. In 2019, DMHC conducted one... Read More »

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Anthem Blue Cross in the DMHC Crosshairs… Over and Over Again

The Department of Managed Health Care (DMHC) is a California government agency tasked with protecting the rights of consumers to receive the benefits and services their health plans are supposed to provide. When health insurers fail to do their jobs, the DMHC Office of Enforcement is there to hold them accountable for their failings... Read More »

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