Anthem Blue Cross of California
Anthem Blue Cross of California is the largest personal insurance provider in California. Anthem provides health, small group, vision, dental, and life insurance to millions of Californians. Every day policyholders apply for and receive benefits under their policy, and insurance works as it should. However, in a number of instances, Anthem’s zest for profits and cost-containment may get in the way of making sound policy decisions that provide insureds with the benefits and coverage they paid for and need.
Anthem does not always act in good faith towards its policyholders in evaluating claims and complaints, and it does not always reach the right conclusion regarding policy coverage. Unfortunately, a wrongful denial of coverage can leave policyholders without important medical treatment or force them to pay thousands out-of-pocket to get the care they need. That’s money most people can’t afford to pay, and they shouldn’t have to.
The passionate and dedicated insurance lawyers at Gianelli & Morris have been protecting policyholders from the wrongful acts of insurance companies since 1979 and are ready and waiting to help you get the recovery you deserve if you have been denied coverage in bad faith or otherwise treated unfairly by Anthem.
All too often, health insurance companies seek to deny coverage for reasons that don’t stand up to scrutiny or even common sense. It seems at times their business models rely on refusing to provide the very service they exist to provide: covering insurance claims. Anthem is no exception. They may deny your claim for one of a variety of reasons, including:
- A procedure is too “investigational” or “experimental”
- A procedure is “cosmetic” or otherwise not medically necessary
- Delay or denial to authorize certain treatments like specialist care, MRI, or other diagnostic procedure
Anthem has a history of wrongfully denying coverage of procedures or treatments by narrowly defining “medically necessary” or expansively defining “experimental.” For example, Anthem previously denied coverage for Harvoni, a proven cure for people with persistent Hepatitis C infections. Because the drug was expensive, Anthem refused coverage for patients unless they had sufficiently “severe” Hepatitis C (e.g., liver fibrosis or cirrhosis). Needless to say, denying a sick person a cure because they are not yet sick enough is an improper basis for refusing coverage, to say the least.
Anthem’s behavior in other states demonstrates its view of policyholders’ right to medical care
In recent years, Anthem’s affiliates in Kentucky, Indiana, Georgia, Missouri, and Ohio established an official policy of refusing to cover emergency room visits if Anthem determined that the ER treatment was “unnecessary.” This left policyholders experiencing symptoms, such as severe chest or abdominal pain, with the distrssing dilemma of trying to self-diagnose whether they were suffering an actual life-threatening condition that would make an ER visit “necessary,” or whether they should instead risk permanent injury or death by first going to another doctor or urgent care clinic regardless of their intense symptoms. If a doctor cannot diagnose a serious condition without examination, how is a regular person supposed to do so?
A 2018 article in the LA Times reporting on this practice began, “In the last few years, Anthem Blue Cross has made a strong bid for the award for the most heartless and senseless coverage policy in the health insurance business.” While this policy has not officially been implemented in California, it shows just how far Anthem may go as a company to avoid paying medical claims or discourage people from seeking medical treatment.
Gianelli & Morris is familiar with Anthem’s bad faith actions
Bad faith means more than just wrongful coverage denials. Bad faith behavior can also include underpayment of claims, delayed payment of claims, delayed responses to claims, lack of claim investigation or simply canceling a claim inappropriately. It is essential that policyholders know their rights with regard to their insurance companies, and if an insurance company appears to be skirting their responsibility to evaluate and pay out on claims, then policyholders should contact an experienced and effective insurance bad faith attorney to review their case.
Attorney Robert Gianelli recently filed a lawsuit against Anthem on behalf of a client who was wrongfully denied benefits by Anthem and generally treated with bad faith. In that matter, Anthem inappropriately deemed that a procedure was “cosmetic” and denied coverage, after diagnosis of a debilitating condition was made by an in-network doctor and confirmed by an out-of-network doctor to whom the client was specifically sent by Anthem and the in-network doctor for a procedure. This lawsuit alleges that Anthem intentionally delayed in responding to the client’s initial claim, failed to properly investigate the claim, ignored medical evidence and information, and wrongfully categorized a procedure in order to deny coverage.
If Anthem Has Wronged You, Our Los Angeles Insurance Attorneys Can Help
Do not let another day pass without seeking legal help from an insurance lawyer. Bad faith is a severe issue that many people may not even realize is affecting them. Proving insurance bad faith can be very difficult, which is why you need an assertive legal advocate in your corner.
At Gianelli & Morris, we have represented policy holders since 1979 and have seen positive results time and time again. We have extensive experience with bad faith behavior and coverage denial, and we can help you determine if you have a valid bad faith case and decide how to go about it.