Recent Blog Posts
Can AI Help You Fight an Insurance Denial?
When your health insurance claim is denied, the appeals process can be daunting, to say the least. Knowing what to say and how to say it can be puzzling, and it comes at a time when you’re already stressed about your health. Recently, new AI-powered health advocate tools have emerged that promise to make… Read More »
Timely Access to Care in California: Lessons from Real-World DMHC Case Studies
Timely access to healthcare isn’t just a regulatory requirement in California; it’s a fundamental right for policyholders under managed care plans. Despite the protection in law, some insurers and health plans fail to meet their obligations, leaving patients without the care they need. The California Department of Managed Health Care (DMHC) enforces these rules,… Read More »
Timely Access to Care: What It Is, Why It Matters, and How California Law Protects You
When you or a loved one needs medical care, how soon you can get that care often matters as much as what kind of care you receive. In California, insured patients under managed care plans have legal rights to timely access, meaning that their health plan must ensure covered services are provided without undue… Read More »
Health Insurance Legal Claims in California
As more California residents face health insurance denials for medically necessary care, the need for skilled legal advocacy has never been greater. Insurance companies have a legal and ethical duty to act in good faith, meaning they must handle your claim fairly and promptly. Unfortunately, many fail to live up to that obligation, leaving… Read More »
California’s Insurance Regulator Cites Health Plans for Failing to Provide Basic Health Care Services
California law is quite clear. State statutes and regulations require health plans to cover “basic health care services” among other requirements, but even this simple mandate seems beyond the willingness or ability of many health plans to meet. Here’s a look at some of the law’s most basic requirements, along with recent examples of… Read More »
Anthem Forced by Regulators to Issue Nearly $63 Million in Rebates to Customers
California Insurer Didn’t Meet Minimum Threshold in Spending Its Money on Medical Services and Quality Care The Department of Managed Health Care (DMHC), responsible for protecting consumers’ health care rights and ensuring a stable health care system by overseeing managed health care plans in California, recently found Anthem sorely lacking in the amount of… Read More »
DMHC Processes over 1,500 Member Complaints Against Anthem in 2023
In California, the Department of Managed Health Care (DMHC) regulates health insurers operating in the state, making sure they comply with state and federal laws and holding them accountable when they don’t. A good portion of the agency’s oversight begins with complaints from policyholders regarding the way their health plan is treating them. When… Read More »
DMHC Releases 2023 Data of Independent Medical Reviews Concerning Anthem, Blue Cross, Blue Shield and Others
The Department of Managed Health Care (DMHC) is the state agency in charge of regulating health insurance plans in California, with the goal of ensuring compliance with state and federal laws. Policyholders can file consumer complaints with the DMHC when they feel they are not being treated properly by their insurer. In the case… Read More »
When Cost Cuts Hurt: Health Plans Dropping Coverage for FDA‑Approved Weight‐Loss Drugs
Imagine finally finding relief in an FDA-approved weight‑loss medication, only to have your insurer drop coverage and leave you shouldering steep costs. That’s the reality for many Americans as major health plans rapidly retreat from covering GLP-1 weight‑loss drugs, despite their proven benefits. Insurers cite cost, yet the impact on patients with obesity or… Read More »
When “Covered” Becomes a Lie: The Role of Ghost Networks in Insurance Denials
Imagine purchasing health insurance with the belief that mental health services are within reach—only to discover that in-network providers are unreachable, unresponsive, or simply don’t exist. This happened to Arizona resident Ravi Coutinho, whose tragic story exposes the dark reality of so-called “ghost networks.” Ravi’s case is a stark example of how insurers can hide… Read More »