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Overcharging on Warning Road Sign.

Blue Shield is Overcharging Policyholders in Violation of California Law

By Gianelli & Morris |

Maintaining continuous health insurance coverage is critical, especially if you or other members of your family have a serious health condition. In the current market for health insurance, premiums are subject to rise a substantial amount each year, sometimes making policyholders’ current plans unaffordable for the following year. Policyholders are entitled to written notice… Read More »

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Health Plan Information Examination Concept

Claim Denials Based on “Experimental” Treatments

By Gianelli & Morris |

When insurance companies get it wrong, Gianelli & Morris makes it right Health insurance providers rely heavily on three reasons for denying their insured customers’ claims for health care benefits: that the sought-after treatment is experimental, that it is investigational, or that it is not medically necessary. Often, these reasons for claim denial are… Read More »

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inside of letter that reads stamped caption FINED

Anthem Blue Cross Receives Hefty Fine for Failures in Handling Customer Complaints

By Gianelli & Morris |

Anthem Blue Cross, one of California’s largest providers of health insurance, has recently reached a settlement with the California Department of Managed Health Care (DMHC) to address major flaws in its handling of customer complaints. Anthem will now be compelled to spend over $11 million in fines and investment in improving the customer grievance… Read More »

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friendly female doctor with patient in office at reception

How Does a California Insurance Bad Faith Claim Work?

By Gianelli & Morris |

Health insurance is designed to provide its customers with care when they become sick or injured, yet insurance companies are known to unreasonably deny claims for coverage that would cut into their profits. Insurance companies already rake in billions of dollars in profits through the premiums they collect; refusing to pay valid claims is… Read More »

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New aluminum prostheses legs for amputee patient

Insurers Facing Lawsuits over Denials of Microprocessor Prostheses

By Gianelli & Morris |

Losing a limb can change someone’s life forever. While it may never be possible to regain full mobility or use of the limb that was lost, prosthetic technology has come a long way in developing prostheses that can respond to surface conditions in real time. Sadly, many patients who would benefit from these technologies… Read More »

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Artificial intervertebral disc prosthesis is installed between the cervical vertebrae

ADR Can Yield Better Results than Fusion, so Why Do Insurance Companies Try to Deny It?

By Gianelli & Morris |

Artificial Disc Replacement (ADR) surgery has existed as an alternative to spinal fusion for over 30 years. Many doctors and researchers will attest that ADR provides more successful outcomes for patients than spinal fusion, offering a shorter recovery period and reducing the likelihood that patients will need additional surgical procedures in the future. ADR… Read More »

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law and justice concept, client discussion lawyer judgement lawsuit with holding pen, law book,gavel and scales of justice at table in office.

What is the Statute of Limitations for a Bad Faith Claim against a California Insurer?

By Gianelli & Morris |

California residents who enter into a contract for health insurance have a right to expect that, if they pay all premiums and co-pays, their injuries, illnesses, and other medical needs will be covered by their insurer according to the terms of their coverage. If benefits are withheld without good reason, the insurer may face… Read More »

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Bad faith lawyer standing in front of pack of lawyers

How Do I Choose the Right Lawyer for My Bad Faith Claim?

By Gianelli & Morris |

If you believe that you’ve had an insurance claim denied wrongfully, you may have the right to file a lawsuit for money damages. These claims can be complex, involving not only contract laws and California laws governing health insurer conduct, but also medical research and best practices. Not every attorney has the skills and… Read More »

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Insurance Consumer Complaints against denial of medical claims

DMHC Consumer Complaints 2017 Annual Report Exposes Bad Faith Denials

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 is an excess skin removal surgery

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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