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 »
When a health insurance claim is denied in California, many policyholders turn to the Department of Managed Health Care (DMHC) for help. The DMHC plays an important role in regulating health plans and enforcing compliance with the law. However, its authority has important limitations, especially when it comes to compensating individuals who have been... Read More »
When a health insurance company denies a request for coverage, most policyholders focus on the outcome: the treatment will not be approved. But under California law, how that denial is communicated is just as important as the decision itself. A denial letter is not a formality. It is a legally required document that must... Read More »
Last month we reported on a $15 Million penalty levied on Blue Cross of California d.b.a. Anthem Blue Cross by the California Department of Managed Health Care (see Department of Managed Health Care Hits Anthem with $15 Million Penalty and Corrective Action, posted on February 17, 2026). While significant, it is not the only... Read More »
Health insurance denials do not always come in the form of a written refusal. Sometimes the most damaging conduct is delay. A postponed authorization. A referral that sits unprocessed. A surgery cancelled days before it was scheduled. A specialist appointment pushed out for months. Under California law, timely access to care is not optional.... Read More »
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