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Insurance Denials/Bad Faith Information, News & Blogs

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How Long Does the Insurance Company Have to Respond to an Appeal?

By Gianelli & Morris |

It can feel as though health insurers hold all the cards when you’re fighting to have a claim approved, and receiving a denial of coverage for the medical care you need can be frustrating and scary. Every California health insurance carrier has its own procedure that policyholders must follow to appeal denied claims. However,… Read More »

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Medical Health Care

How to Appeal an Insurance Claim Denial

By Gianelli & Morris |

Receiving a denial from your health insurance provider can be scary and discouraging, but denial isn’t always the end of the road. Every California health insurance policyholder has a right to appeal the denial of a claim, either on their own or with the help of an experienced attorney. Read on to learn how… Read More »

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What Does California Law Require from a Health Insurance Grievance System?

By Gianelli & Morris |

In a recent post, we reported on a Department of Managed Health Care (DMHC) survey of the quality of care offered by Anthem Blue Cross to its California policyholders. The survey found 14 serious shortcomings, ten of which were shortcomings in the manner in which Anthem operated its customer grievance system. The DMHC’s report… Read More »

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State Agency Finds Anthem Blue Cross Lacking in Significant Ways

By Gianelli & Morris |

A recent California state agency review of the service provided by Anthem Blue Cross to its policyholders found the healthcare provider deficient in fourteen significant ways. When the agency gave Anthem a second chance to improve its performance score, the insurer showed improvement in only one of the fourteen deficient areas. Learn more about… Read More »

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Writing note showing Claim Denied. Business photo showcasing Requested reimbursement payment for bill has been refused Clothespin holding yellow note paper crumpled papers several tries.

Report Blasts Anthem for Denying ER Service and Treatment

By Gianelli & Morris |

The California Department of Managed Health Care (DMHC) conducts routine surveys of every California health care service plan at least once every three years, examining such factors as how each plan addresses customer grievances, how it makes health care services available, and the access to and payment for emergency services that it provides to… Read More »

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Medical Necessity form on a table.

Why Claims Get Denied: Medical Necessity

By Gianelli & Morris |

Recently, we published an article on denials of claims for health insurance benefits as “experimental,” one of the most-commonly-used excuses for the denial of a health insurance claim. Another commonly-provided reason for California health insurance claim denials is that the sought-after treatment is not medically necessary. Like denials based on the alleged experimental nature… Read More »

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Can You Sue Your Insurance Company for Taking Too Long?

By Gianelli & Morris |

Recovering fully from a severe illness can be a race against the clock. Once your physician has diagnosed your condition and determined the best course of treatment, you naturally want to start that treatment as soon as possible. Most medical conditions will get worse without treatment, and some can even go from treatable to… Read More »

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Insurers’ Duty to Investigate Claims Prior to Denial

By Gianelli & Morris |

When you submit a claim to your California health insurance provider, that insurer must carefully examine your claim before approving or rejecting it. Even when the claim is for coverage of a new or nontraditional procedure, your insurer has a responsibility to consider why it might be the best course of action in your… Read More »

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When Can a Health Insurer Cancel an Insurance Policy in California?

By Gianelli & Morris |

If you or a member of your family is going through a health crisis, there are few pieces of news as devastating as hearing that your health insurance policy has been canceled. Abruptly losing your insurance can mean that you’re forced to pay out of pocket for costly treatments, if the necessary procedures are… Read More »

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wrapped hand holding an envelope with a work injury claim application inside stamped with denied

Does Egan’s “managing agent” rule survive 40 years later?

By Gianelli & Morris |

Most Insurance Bad Faith Cases Involve A Fight Over The Managerial Status Of The Employees Who Denied The Insured’s Claim Forty years ago, the California Supreme Court upheld a punitive-damage award against an insurer based on the acts of a claims adjuster in denying a single claim. Because the adjuster had the authority to… Read More »

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