Insurance Denials/Bad Faith Information, News & Blogs
No Suprises Act Stops Balance Billing From Out-of-Network Providers of Emergency Care
Say you go to a doctor or hospital that you know is in your insurance network. You pay your deductible and/or co-pay and expect the rest will be covered by insurance. Weeks or months later, you get an unexpected bill in the mail. While the office or facility you visited was in-network, one or… Read More »
What if the Insurance Company Says Your ER Visit Wasn’t an Emergency?
Insurance companies don’t like ER visits because they are much more expensive than a scheduled doctor visit or even a trip to urgent care. Regardless, emergency departments exist for a reason. People do have medical emergencies, and emergency room physicians are specially trained in emergency medicine to deal with any kind of emergency, including… Read More »
Crisci v. Security Insurance Company
Despite California’s existence as a state since 1850, bad faith insurance law was still being laid down in the courts as late as the 1960s and 70s and continues to be shaped today. Let’s take a look back at one of the landmark bad faith insurance cases in the state, with a ruling by… Read More »
The True Cost of Health Insurance Claim Denials
How Denials Can Put You in the Poor House, Worsen Your Health, or Both KFF Health News is a leading source of media coverage on healthcare policy. KFF was formerly known as Kaiser Family Foundation, but it changed its name to avoid being confused with the HMO giant Kaiser Permanente, with which it is… Read More »
California Expands Medi-Cal Coverage Yet Again
Leading the Nation in Serving the Health Care Needs of Low-Income Families and Undocumented Residents Starting on January 1 this year, California became the first state in the nation to ensure that all low-income residents qualify for Medi-Cal, the state’s version of Medicaid. The expansion includes undocumented immigrants who are otherwise eligible for Medi-Cal… Read More »
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 »
