Anthem Began 2026 With a $15 Million Penalty from the California State Regulator, but More Enforcement Actions Keep Rolling in

Last month we reported on a $15 Million penalty levied on Blue Cross of California d.b.a. Anthem Blue Cross by the California Department of Managed Health Care (see Department of Managed Health Care Hits Anthem with $15 Million Penalty and Corrective Action, posted on February 17, 2026). While significant, it is not the only instance of Anthem getting in hot water with the DMHC so far this year. At the time of this writing, Anthem has already been the subject of four other enforcement actions totaling another $155,000. While only a fraction of the $15,000,000 fine, which covered 23 separate instances of Anthem’s failure to adequately consider an enrollee’s grievance and failure to establish and maintain an approved grievance system, these other actions reflect Anthem’s inexcusable failures to explain the reasons why it denied a member’s claim for benefits. That’s 27 enforcement actions this year to date, and we aren’t even through the first quarter of 2026.

Below, we take a look at these other four enforcement actions against Anthem, which, of course, is only one of more than 150 health plans regulated by the state of California. If your insurance company has denied your claim for healthcare coverage or benefits without giving a reasonable explanation or following required legal procedures, contact Gianelli & Morris to speak with a California insurance bad faith lawyer experienced in holding Anthem and other insurers liable for misconduct.

Unlawful Claim Denial

In January, DMHC struck Anthem with a $45,000 penalty for three statutory and regulatory violations, including, notably:

• Failure to provide an accurate and clear written explanation of the specific reasons for denying, adjusting, or contesting a claim, in violation of Health and Safety Code section 1371, subdivision (a)(1)
• Failure to timely reimburse, contest, or deny a claim or identify the portion of the claim being contested and the specific reasons why, in violation of California Code of Regulations, title 28, section 1300.71, subdivision (d)(1)

In this case, the Anthem enrollee had Anthem PPO as their secondary plan, but a coordination of benefits provision in Anthem’s plan required it to coordinate benefits for enrollees with dual coverage. The enrollee received services from an out-of-network provider, which were paid proportionately by the primary plan. Anthem, however, failed to approve its portion of the claim, first alleging they were “waiting for more information from the doctor” and later using the primary plan’s payment as an excuse not to cover their portion. By the time the complaint reached the DMHC, Anthem had already assigned five different claim numbers to the enrollee’s request for payment, each time citing a different reason to deny the claim. One claim was denied without any reason attached, and another was denied because Anthem said, ironically, “we already have this claim.”

After DMHC got involved, Anthem finally reprocessed the initial claim and admitted its errors in causing the delay.

Emergency Transportation Not Covered Despite EOC

In February, Anthem got hit with $60,000 in penalties. This time, an enrollee took emergency transport from one facility to another. Both facilities were in-network, but the transportation company was out-of-network. Anthem applied the out-of-network deductible rate to the claim, “leaving the enrollee with a significant balance.” The enrollee’s Evidence of Coverage (EOC), however, clearly stated that emergency transport services should be charged the in-network deductible and paid at the usual and customary rate. Here it seems Anthem violated its own EOC as well as California laws and regulations.

Unpaid Claims Send Patient Into Collections

The final two enforcement actions under discussion were issued on March sixth of this year, both related to the same complaint. In this case, the enrollee received covered chiropractic visits from an in-network provider. Despite receiving several EOBs indicating the claims were being processed, they were never processed or paid. Instead, the entity to whom Anthem delegated its claim processing denied the claims by falsely stating the provider was out-of-network. The enrollee started getting bills from the provider amounting to over $3,000, along with a warning that the account would be sent to collections if not paid, which apparently did occur. Upon review, Anthem admitted that the provider did show up as in-network with Anthem but not with the delegated entity. Although Anthem indicated it was fixing the problem, months later the claims were still being misprocessed, leaving the enrollee with an unpaid balance that led the chiropractic provider to stop accepting appointments for the enrollee.

The DMHC decided that a $50,000 administrative penalty was appropriate given these multiple errors.

Fight Insurance Bad Faith in California With Gianelli & Morris

No doubt we haven’t seen the last of enforcement actions against Anthem for 2026. Anthem’s record with the DMHC in 2025 included 330 enforcement actions against the insurer, amounting to over $3 million in penalties. Sadly, even January’s $15 million fine might not do much to deter the actions of a company that generates over $100 Billion a year in revenue; it is also important to note that these administrative penalties go to the state, not the insured who was harmed by the insurer’s wrongful conduct.

The attorneys at Gianelli & Morris in Los Angeles focus their practice on holding insurance companies accountable to the people they have harmed by their bad faith actions, including seeking full compensatory damages as well as punitive damages in appropriate cases. If your health insurance claim was wrongfully denied or mishandled, contact our office for a free consultation with our dedicated California insurance bad faith lawyers.