Insurance Denials/Bad Faith Information, News & Blogs
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 »
Anthem Blue Cross Visited With $95,000 in Penalties in January
Only one month into the new year, the California Department of Managed Health Care has already issued two enforcement actions against Blue Cross of California d.b.a. Anthem Blue Cross, penalizing the company $75,000 on January 14th and $20,000 on January 17th. The actions by the state regulator penalize Anthem for violating California law in… Read More »
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 »
