Insurance Denials/Bad Faith Information, News & Blogs
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 »
Anthem Loses (and Wins) in a Lawsuit Filed by California Hospital Association for Violating California Patient Protection Laws
Last April, the California Hospital Association (CHA), a nonprofit member organization representing over 400 hospitals and health systems throughout California, sued Anthem Blue Cross in Los Angeles County Superior Court, alleging that certain Anthem practices were depriving patients of timely post-hospital health care and forcing hospitals to provide (and pay for) additional care after… Read More »
Anthem Blue Cross Fined $550,000 for Two-Month Delay in Approving Therapy After an Independent Medical Review Found the Service Was Medically Necessary
The Department of Managed Health Care (DMHC) is a California state agency charged with regulating insurance companies offering health plans in the state. When insurers violate laws intended to protect consumers and ensure access to adequate healthcare, the DMHC’s Office of Enforcement has many tools at its disposal to punish violators and order corrective… Read More »
By the Numbers: DMHC Enforcement Actions Against Insurance Companies in 2025 (So Far)
The California Department of Managed Health Care (DMHC) licenses and monitors health plans operating in the state. The DMHC Office of Enforcement works to change plan behavior to comply with the law, utilizing enforcement actions including cease and desist orders, administrative penalties (fines), freezing enrollment, and requiring corrective actions. In some cases, the DMHC… Read More »
Why Are Health Insurance Denial Cases So Complicated?
When a health insurance company denies a valid claim, it’s more than just a financial setback—it’s a betrayal of trust at a time when policyholders are most vulnerable. Unfortunately, pursuing legal action against an insurance company for a wrongful denial isn’t as simple as it may seem. Health insurance denial cases are legally and… Read More »
What Is Evidence of Coverage?
If you’ve ever had a health insurance claim denied, the reason may have had something to do with a document called the Evidence of Coverage (EOC). While most people don’t pay much attention to this document when signing up for a health plan, it becomes critically important when a health insurer denies a service,… Read More »
Health Insurance Claim Wrongfully Denied? Why You Need an Insurance Law Attorney and Not a Personal Injury Lawyer
If your health insurance claim has been denied in bad faith, you may be wondering what kind of legal help you need. Many people assume that a personal injury lawyer is the right choice, especially if they have been physically harmed by a claim denial or unreasonable delay. But bad faith insurance cases are… Read More »
