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Anthem Blue Cross Medi-Cal Denials

anthem blue crossAnthem Blue Cross is the single largest provider of insurance in the state of California. Its insurance lines include life, health, vision and dental, covering millions of Californians statewide. A large bulk of those Californians receive coverage through Medi-Cal, the state’s version of Medicaid. Anthem serves Medi-Cal recipients in Los Angeles, San Francisco, Sacramento, Fresno, and a dozen other counties in California.

Medi-Cal recipients are not second-class citizens, and they should expect to be treated as valued customers by their insurance company. If Anthem wrongfully denies your claim for healthcare services, they can be liable for breach of contract as well as insurance bad faith, entitling you to significant compensation for the harm done by their wrongful conduct, including punitive damages for especially wrongful treatment of you and your claim. Gianelli & Morris, a Los Angeles-based California insurance law firm, can help you hold Anthem accountable for its misdeeds and help you find the healthcare, justice and compensation you deserve.

Which Medi-Cal Recipients Does Anthem Serve?

Anthem currently services Medi-Cal recipients in Alpine, Amador, Calaveras, El Dorado, Fresno, Inyo, Kern, Kings, Los Angeles, Madera, Mono, Sacramento, San Francisco, Santa Clara, Tulare, and Tuolumne counties. Persons eligible for Medi-Cal include:

  • Pregnant women
  • Low-income families with children
  • Seniors (age 65 or older)
  • People with disabilities
  • Children in foster care
  • Former foster youth up to age 26
  • People with specific diseases like breast or cervical cancer, tuberculosis or HIV/AIDS

What Services Does Anthem Provide to Medi-Cal Recipients?

Anthem Blue Cross is expected to provide the full range of healthcare coverage to Medi-Cal beneficiaries. These services should include medical care, referrals and preapprovals, pharmacy and prescription drugs, dental and vision care, transportation services, care management programs, long-term services and supports, and more.

How Does Anthem Provide Medi-Cal Coverage?

Many people who opt for private health insurance or get their health coverage through their employment enjoy the freedom and flexibility of a PPO plan from Anthem Blue Cross. In a PPO (Preferred Provider Organization), policyholders get to see whichever doctor they want, including specialists, whenever they choose. Insurance benefits vary depending on whether the doctor, pharmacist, hospital, or other healthcare provider is inside or outside of the PPO network, but the choice lies with the patient to select the medical care they deem will best meet their needs.

For people on Medi-Cal, however, Anthem offers a less attractive alternative to a PPO. Medi-Cal through Anthem is HMO-based. Through an HMO (Health Maintenance Organization), policyholders are not allowed to go out of network and see whomever they choose. Even inside the HMO network, patients must first get pre-approval from their Primary Care Physician (PCP) before seeing a specialist. The PCP acts as a gatekeeper to keep costs down for the insurer, which may not be in the patient’s best interests.

Similar to the HMO gatekeeper concept, Anthem contracts with the California Department of Managed Health Care to provide managed care plans, in which most Medi-Cal recipients are required to participate. Managed care reinforces the gatekeeper concept and further restricts access to care by requiring prior authorization before receiving many procedures or services.

Bad Faith Medi-Cal Insurance Hurts the People Who Need Help the Most

Medi-Cal not only serves the poorest Californians but also those who are most in need of quality health care, such as children in foster care, pregnant women, and the elderly or disabled. Wrongful denials of medical care hit these most vulnerable populations especially hard. As attorneys who take on insurance companies across the state when they act in bad faith and unreasonably deny medical care or procedures to patients who need them, we understand the toll bad faith practices take on a patient’s physical health and emotional well-being. Our firm is a voice for people who need someone to stand up for them, and we welcome the opportunity to advocate on behalf of California Medi-Cal recipients who have been harmed by Anthem’s bad faith insurance practices.

Contact Gianelli & Morris for Help With Wrongful Anthem Blue Cross Medi-Cal Insurance Claim Denials

If you have been mistreated by Anthem Blue Cross, Blue Shield of California Promise Health Plan, or L.A. Care, the insurance bad faith lawyers at Gianelli & Morris are here to help you get the justice, compensation, and medical care you are entitled to. For help throughout the state of California, call our office in Los Angeles at 213-489-1600 for a free consultation to discuss your denied claim and find out how we can help.

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