Insurance Denials/Bad Faith Information, News & Blogs
Appeal Letter for Health Insurance Denial
Insurance companies make a number of excuses when they deny coverage –they’ll say the procedure is not medically necessary, the procedure is experimental or is not generally accepted in the medical community, there is a cheaper, better alternative, etc.–but what insurance companies really care about is their bottom line. When they deny you coverage… Read More »
What to Do if Insurance Denies Surgery
Insurance companies are worried first and foremost about their bottom line. They will look for any reason to save money, even if that means denying coverage for medical procedures approved and recommended by your doctor. What can you do if your insurance company denies coverage for a surgery recommended by your doctor? Continue reading… Read More »
How Long Does an Insurance Appeal Take?
If you are hurt and you file a claim with your health insurance company, they must respond within a reasonable amount of time under California law. The law requires them to evaluate your claim appropriately, and if they choose to limit or deny your coverage, they must provide you with an explanation as to… Read More »
What is a Material Misrepresentation by an Insurance Company?
We’ve all heard the term “insurance fraud.” Insurance fraud happens when you lie to an insurance company to collect undeserved benefits, such as by burning down your own property and claiming someone else did it so that you can collect a payout. Well, insurance companies are required by law and contract to be just… Read More »
How Long Does the Insurance Company Have to Respond to an Appeal?
It can feel as though health insurers hold all the cards when you’re fighting to have a claim approved, and receiving a denial of coverage for the medical care you need can be frustrating and scary. Every California health insurance carrier has its own procedure that policyholders must follow to appeal denied claims. However,… Read More »
How to Appeal an Insurance Claim Denial
Receiving a denial from your health insurance provider can be scary and discouraging, but denial isn’t always the end of the road. Every California health insurance policyholder has a right to appeal the denial of a claim, either on their own or with the help of an experienced attorney. Read on to learn how… Read More »
What Does California Law Require from a Health Insurance Grievance System?
In a recent post, we reported on a Department of Managed Health Care (DMHC) survey of the quality of care offered by Anthem Blue Cross to its California policyholders. The survey found 14 serious shortcomings, ten of which were shortcomings in the manner in which Anthem operated its customer grievance system. The DMHC’s report… Read More »
State Agency Finds Anthem Blue Cross Lacking in Significant Ways
A recent California state agency review of the service provided by Anthem Blue Cross to its policyholders found the healthcare provider deficient in fourteen significant ways. When the agency gave Anthem a second chance to improve its performance score, the insurer showed improvement in only one of the fourteen deficient areas. Learn more about… Read More »
Report Blasts Anthem for Denying ER Service and Treatment
The California Department of Managed Health Care (DMHC) conducts routine surveys of every California health care service plan at least once every three years, examining such factors as how each plan addresses customer grievances, how it makes health care services available, and the access to and payment for emergency services that it provides to… Read More »
Why Claims Get Denied: Medical Necessity
Recently, we published an article on denials of claims for health insurance benefits as “experimental,” one of the most-commonly-used excuses for the denial of a health insurance claim. Another commonly-provided reason for California health insurance claim denials is that the sought-after treatment is not medically necessary. Like denials based on the alleged experimental nature… Read More »
