Insurance Denials/Bad Faith Information, News & Blogs
How AI Is Failing Insureds: The Dark Side of Automation in Health Insurance
Artificial intelligence (AI) has revolutionized industries worldwide, promising greater efficiency, cost savings, and improved decision-making. In the health insurance sector, insurers have embraced AI to automate claims processing, detect fraud, and assess risks. While these advancements sound promising, the reality for many insured individuals has been far less optimistic. AI is increasingly being used… Read More »
How Insurance Companies Look for Ways to Deny Claims Rather Than Pay Them
When you purchase health insurance, you trust that your insurer will be there when you need them the most—during times of illness or injury. Unfortunately, it often seems like insurance companies prioritize corporate profits over policyholder needs, even to the extent of employing tactics to deny legitimate claims. We take a look at some… Read More »
Carelon and Its Role in Your Health and Health Insurance Claims
Handling a health insurance claim is often challenging, especially when dealing with lesser-known entities like Carelon. If you’re a California consumer whose health insurance claim has been denied, it’s crucial to understand the role companies like Carelon play in managing claims and their relationship with larger insurers, such as Anthem. Below, we delve into… Read More »
Did AI Handle Your Insurance Claim?
Insurance companies are increasingly relying on artificial intelligence (AI) to make decisions about health insurance claims. While AI has the potential to improve efficiency, it raises significant concerns about fairness and legality when it comes to handling claims. California law requires insurers to conduct a thorough, individualized review of every claim, and decisions made… Read More »
Blue Cross Plans Fined $8.5 Million by State Regulator for Failing to Promptly Address Claims Payment Disputes With Providers
Two Blue Cross insurance plans were recently fined a total of $8.5 million by the California Department of Managed Health Care (DMHC) for failing to acknowledge and resolve provider disputes within the time frames required by law. These serious failures on the part of Blue Cross could ultimately harm patient care and are indicative… Read More »
Why Claim Automation Is Not in Your Best Interest
In today’s rapidly evolving digital world, automation is becoming more prevalent across many industries, including insurance. Health and life insurance companies increasingly rely on automated systems to process claims. While this may seem like a step toward efficiency, the reality is that claim automation often works against policyholders; it can even result in the… Read More »
Anthem Fined $450,000 for Blanket Exclusion of Sex Reassignment Surgery
Health insurance is for everyone, and California law makes it clear that insurance companies are not allowed to impose exclusions, charge differentials, or other modifications of enrollee benefits based on race, color, national origin, ancestry, religion, sex, gender, marital status, sexual orientation, or age. One exception is that premiums, prices and charge differentials based… Read More »
Anthem Blue Cross Hit With $162,000 in Penalties for Grievance Violations in August
For years now, insurance companies like Blue Cross of California d.b.a. Anthem Blue Cross have been made aware of the requirements under California to maintain a policy and procedure to receive and process customer complaints (grievances) and to respond to complaints and resolve them within the time frame specified in the law. Nevertheless, companies… Read More »
Failing to Explain a Denial
When a policyholder files a claim with their health or life insurance company, they expect a fair evaluation and a clear explanation if their claim is denied. Unfortunately, some insurers engage in practices that fall short of this expectation, including failing to promptly explain the reasons behind a denial. In California, this failure can… Read More »
Anthem Fined $30,000 for Failing to Provide DMHC With Information Used to Resolve Grievances
Not only does Anthem consistently fail to respond to customer complaints in a timely manner if at all, they don’t even respond well to requests from the California state insurance regulator. The regulator, the Department of Managed Health Care (DMHC), has the authority to assess administrative penalties, but it seems even slapping the company… Read More »
