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Department of Managed Health Care Report Exposes Bad Faith Denials among California Health Insurance Providers

By Gianelli & Morris |

The California Department of Managed Health Care (DMHC) is the regulatory office charged with overseeing the majority of health insurance coverage in the state. Health insurance policyholders can report disputes with their insurance provider to the DMHC, which will investigate those complaints, conduct independent medical reviews of denied claims, and carry out enforcement actions… Read More »

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Bariatric Surgery - medical concept

Insurers Deny Coverage for Excess Skin Removal Following Bariatric Surgery

By Gianelli & Morris |

As we have discussed time and again, insurers are always looking for reasons to deny coverage. Particularly where a procedure could possibly be defined as “cosmetic,” insurers will refuse coverage if they can find any justification to do so. But even so-called cosmetic issues can be disabling and disfiguring, and California law does not… Read More »

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What is Insurance Bad Faith, and What can You do about It?

By Gianelli & Morris |

Insurance policyholders who are current on premiums and follow the rules have a legal right to receive coverage for claims included under the terms of their policy. If health insurers fail to provide payment for these covered claims, they’re not only breaching their contract and breaking the law, they’re potentially putting their policyholder’s life… Read More »

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Health Insurance Denied

Insurance Companies Are Denying Coverage For Lipedema Treatments

By Gianelli & Morris |

Lipedema is a very common yet serious, painful, and crippling condition that affects nearly 11% of adult women worldwide. There are known treatments for lipedema, but insurance companies have taken strong stances against covering the cost of these cures for their paying policyholders. The dedicated and compassionate Los Angeles insurance bad faith attorneys at… Read More »

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Signs that read Reconstructive Surgery

Insurance Denial of Reconstructive Surgery

By Gianelli & Morris |

Too often, reconstructive surgery is denied for insurance reimbursement because insurance companies deem the surgery cosmetic and not medically necessary. The insurance companies assert that a medical necessity requires the illness to cause a functional, medical impairment for the patient, and insurance benefits are not available for a procedure done primarily to improve appearance…. Read More »

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Insurance Claim Denied on iPad

Appealing the Denial of an Insurance Claim

By Gianelli & Morris |

Appealing denied insurance claims requires an insured to go through the internal appeals process. When your insurance claim is denied by your provider, be it disability, health, property, life, etc., you have several options. The law entitles you to challenge the denial via one of a number of processes. Your insurance plan will typically… Read More »

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Paper that reads bad faith insurance

Top Signs Your Insurance Denial was in Bad Faith

By Gianelli & Morris |

Insurance companies have a duty to act in “good faith” when responding to policyholder claims. However, we have all heard stories of insurance companies denying claims that seem otherwise legitimate. Insurance companies are private businesses, and first and foremost they care about their profits. Sometimes insurers treat their policyholders less than fairly to protect… Read More »

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Fighting a Health Plan’s “Investigational” Denial of a Medical Claim

By Gianelli & Morris |

Health plan contracts typically have exclusions for treatments that an insurance company considers “investigational” or “experimental.” Health plans say there is insufficient proof demonstrating that certain treatments are safe and effective for their intended use, making them investigational or experimental and not a covered medical benefit. Whether a particular treatment is investigational or experimental… Read More »

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Addressing the Defenses of Abstention, Primary Jurisdiction and Exclusive Jurisdiction in Insurance Class Actions

By Gianelli & Morris |

Published in: Advocate – Journal of Consumer Attorneys Associations for Southern California, September 2016 Issue Authored by: Robert S. Gianelli Downloadable format: To download this document in .pdf format [Click Here] I. Introduction So you have just filed an insurance class action and you are very excited. You have substantial evidence that the defendant… Read More »

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Use and abuse of medical necessity criteria – Health insurers’ denial of the Hepatitis C drug Harvoni

By Gianelli & Morris |

Use and abuse of medical necessity criteria – Health insurers’ denial of the Hepatitis C drug Harvoni. These drugs offer a cure for the estimated 3.2 million people living in the United States with chronic Hepatitis C infection. Published in: Consumer Attorneys Of California January/February 2016 Authored by: Robert S. Gianelli Downloadable format: To… Read More »

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