Insurance Denials/Bad Faith Information, News & Blogs
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 »
What Is a Medical Policy, and Why Is It Important When Your Insurance Claim Is Denied?
If you’ve had a health insurance claim denied, your insurer may have cited a “medical policy” as the reason. But what exactly is a medical policy, and how does it impact your ability to receive the treatment your doctor recommends? Understanding medical policies is crucial when challenging an insurance company’s denial of coverage, and… Read More »
California Firefighters and Health Insurance Denials
Firefighters put their lives on the line every day to protect communities, often facing dangerous and physically demanding conditions. In return, they rely on employer-sponsored health insurance to cover medical expenses. However, when an insurance company wrongfully denies a claim, the consequences can be severe. Fortunately, California firefighters are generally exempt from the Employee… Read More »
How Public Employee Insurance Denials Are Different
When a health insurance company denies a claim, policyholders often assume they have the right to challenge the denial in court and seek compensation for any harm caused. However, the legal options available to policyholders depend largely on whether their insurance plan is governed by the Employee Retirement Income Security Act (ERISA). Most private-sector… Read More »
Anthem is Processing and Handling Insurance Claims Offshore: What Does This Mean for You?
If you have health insurance through Anthem, you expect your claims to be processed fairly and promptly. However, recent reports reveal that Anthem has been outsourcing the handling of insurance claims to overseas contractors, raising serious concerns about delays, denials, and the overall quality of claim reviews. If your health insurance claim has been… Read More »
A Busy January at the DMHC
California’s Health Care Regulator Starts the Year Off Right, Protecting Consumers and Holding Insurance Companies Accountable for Violating the Law The mission of the California Department of Managed Health Care (DMHC) is to protect the healthcare rights of Californians. Consumers can file complaints with the DMHC, and if the agency finds wrongdoing, it can… Read More »
