Insurance Denials/Bad Faith Information, News & Blogs
Gianelli & Morris Sues Anthem, Inc. over Denial of Insurance Coverage for Lipedema
On January 17, 2019, Gianelli & Morris, a Los Angeles insurance bad faith law firm, filed a complaint against Anthem, Inc. and its utilization management arm Anthem UM on behalf of Robin Goolsby, a patient diagnosed with Stage 3 advanced lipedema whose request for coverage for tumescent liposuction was denied. Anthem UM’s denial letter… Read More »
Insurance Denial of Reconstructive Surgery
Too often, reconstructive surgery is denied for insurance reimbursement because insurance companies deem the surgery cosmetic and not medically necessary. The insurance companies assert that a medical necessity requires the illness to cause a functional, medical impairment for the patient, and insurance benefits are not available for a procedure done primarily to improve appearance…. Read More »
Appealing the Denial of an Insurance Claim
Appealing denied insurance claims requires an insured to go through the internal appeals process. When your insurance claim is denied by your provider, be it disability, health, property, life, etc., you have several options. The law entitles you to challenge the denial via one of a number of processes. Your insurance plan will typically… Read More »
Top Signs Your Insurance Denial was in Bad Faith
Insurance companies have a duty to act in “good faith” when responding to policyholder claims. However, we have all heard stories of insurance companies denying claims that seem otherwise legitimate. Insurance companies are private businesses, and first and foremost they care about their profits. Sometimes insurers treat their policyholders less than fairly to protect… Read More »
Fighting a Health Plan’s “Investigational” Denial of a Medical Claim
Health plan contracts typically have exclusions for treatments that an insurance company considers “investigational” or “experimental.” Health plans say there is insufficient proof demonstrating that certain treatments are safe and effective for their intended use, making them investigational or experimental and not a covered medical benefit. Whether a particular treatment is investigational or experimental… Read More »
Class Certified Against United HealthCare for Refusing to Cover Artificial Lumbar Disc Surgery
The United States District Court of the Central District of California has certified a class of plaintiffs in a Gianelli & Morris lawsuit alleging that UnitedHealthcare Insurance Company categorically denies coverage for artificial lumbar disc surgery as “unproven” despite the fact that the surgery is safe and effective. Hill v. UnitedHealthcare Insurance Company, Case… Read More »
LaRue V. Accountable Health Care, IPA
Rob Gianelli of Gianelli & Morris and Rene Kern of the Kern Law Group obtained a $7,225,000 jury verdict on behalf of plaintiff Terry LaRue, against Accountable Health Care, IPA (“Accountable”) for failure to provide LaRue with timely and necessary medical services, resulting in a permanent and disabling injury to his hand. Mr. LaRue’s… Read More »
Addressing the Defenses of Abstention, Primary Jurisdiction and Exclusive Jurisdiction in Insurance Class Actions
Published in: Advocate – Journal of Consumer Attorneys Associations for Southern California, September 2016 Issue Authored by: Robert S. Gianelli Downloadable format: To download this document in .pdf format [Click Here] I. Introduction So you have just filed an insurance class action and you are very excited. You have substantial evidence that the defendant… Read More »
Use and abuse of medical necessity criteria – Health insurers’ denial of the Hepatitis C drug Harvoni
Use and abuse of medical necessity criteria – Health insurers’ denial of the Hepatitis C drug Harvoni. These drugs offer a cure for the estimated 3.2 million people living in the United States with chronic Hepatitis C infection. Published in: Consumer Attorneys Of California January/February 2016 Authored by: Robert S. Gianelli Downloadable format: To… Read More »
Gianelli & Morris wins class certification against Blue Shield over its refusal to cover artificial lumbar disc surgery as “investigational.”
Gianelli & Morris wins class certification in case against Blue Shield over its refusal to cover artificial lumbar disc surgery as “investigational.” Gianelli & Morris has won class certification in a class action lawsuit against Blue Shield of California on behalf of patients who had their requests for artificial lumbar disc surgery denied as… Read More »
