Insurance Denials/Bad Faith Information, News & Blogs
Thirteen Anthem Plan Deficiencies Remain Uncorrected Four Years Later
California’s Department of Managed Health Care (DMHC) routinely surveys health plans in the state to ensure they are complying with the law. Outside of its routine, whenever DMHC has good cause to investigate issues of compliance with the law, it initiates an investigatory survey known as a non-routine survey. In 2019, DMHC conducted one… Read More »
Anthem Blue Cross in the DMHC Crosshairs… Over and Over Again
The Department of Managed Health Care (DMHC) is a California government agency tasked with protecting the rights of consumers to receive the benefits and services their health plans are supposed to provide. When health insurers fail to do their jobs, the DMHC Office of Enforcement is there to hold them accountable for their failings… Read More »
Gruenberg v. Aetna Insurance Company: A Look Back at a Landmark California Bad Faith Insurance Case
The fact that insurance companies cannot deny claims unreasonably or otherwise act in bad faith toward their policyholders seems so obvious that one would expect such has always been the case. But the truth is that the concept of bad faith insurance in California is not that old; the concept was still being laid… Read More »
What’s the Difference Between an HMO and a PPO?
When it comes to health insurance, two common types of plans are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. While both types of plans offer essential health coverage, they differ in structure, cost, and flexibility. They can also have profound differences when it comes to requesting a referral to a specialist… Read More »
The Gatekeeper Concept: How HMOs Operate
Health Maintenance Organizations (HMOs) have become a common choice for many seeking affordable health insurance coverage in California and across the United States. They offer a range of medical services through a network of providers for a fixed, prepaid fee and office visit copayment. However, the operational model of HMOs, particularly the gatekeeper concept,… Read More »
What Is the Department of Managed Health Care?
When it comes to navigating the complexities of health insurance in California, understanding the role and responsibilities of the Department of Managed Health Care (DMHC) is crucial. As a prominent California insurance law firm, Gianelli & Morris champions the rights of victims of insurance bad faith, particularly those who have faced unreasonable claim denials…. Read More »
How Do You Win a Bad Faith Insurance Lawsuit?
When policyholders faithfully pay their insurance premiums, they expect their insurance company to uphold its end of the bargain, especially during times of need. However, situations arise where insurance claims are unreasonably denied, leaving the insured feeling helpless and betrayed. When insurance companies deny claims for improper motives, victimized policyholders may have the basis… Read More »
Reasons Hiring an Insurance Law Attorney to Handle Your Claim Denial Is Essential
Navigating the complexities of insurance claims can be a daunting task, especially when facing an unreasonable denial from an insurance company. In such situations, enlisting the expertise of an attorney experienced in insurance law can provide numerous advantages. Read on for a discussion about why hiring an insurance attorney is critical when fighting an… Read More »
What Is a Bad Faith Insurance Lawsuit and What Are the Grounds
Insurance policies are agreements of trust and assurance. Policyholders pay premiums with the expectation that benefits will be there when they need them and their insurance company will provide the necessary coverage. Unfortunately, this trust is breached all too often, leaving policyholders in a challenging situation, unable to get an important medical procedure or… Read More »
Should You File for Tort Damages in Your Insurance Bad Faith Claim?
Fighting an insurance claim denial is hard enough, but when the insurer isn’t playing fair, you might be understandably even more frustrated and at a loss on how to proceed. California is a consumer-friendly state and has a lot of protections in place for the average Californian going up against a corporate behemoth like… Read More »
