Anthem Blue Cross dba Blue Cross of California has a history of failing to resolve the grievances of their consumers in a timely fashion. In fact, the problem is so severe that in late 2017, California’s managed-care regulator fined the insurance giant $5 million for its failures in this area.
From 2013 to 2016, California government found 245 grievance-system violations at Anthem. Furthermore, in 2016, insurance company denials were overturned in almost 70 percent of medical review cases. However, appealing these denials and getting them overturned can be difficult for even the most insurance-savvy consumer.
If you were wrongly denied an Anthem insurance denial appeal, you do not have to simply accept the denial. A Los Angeles Anthem health insurance denial appeals lawyer can help you take action to get the coverage you need.
Common Reasons for Health Insurance Denials
Health insurance companies such as Anthem are in the business of providing health insurance and of making money. In some instances, health insurance carriers may do everything they can to deny claims to increase their profits. This can be extremely infuriating for the millions of policyholders who faithfully pay their premiums each time they are due.
Common reasons for health insurance claim denials include:
- The service or medical device sought is not medically necessary
- The service sought is investigational or experimental
- The filing deadline expired
- The insured received two services in one day
- The policyholder changed their insurance plan
- The out-of-network benefits are different from in-network benefits
- The insured did not reach their deductible
- The individual made a late payment to COBRA
- The person lacked a physician referral
- The policyholder had a certain procedure that was not covered
For more information or help with filing a claim, get in contact with a Los Angeles Anthem health insurance denial appeals lawyer today.
Applicable Laws in Anthem Appeals
Anthem is a commercial enterprise that must answer to a higher chain of command. Most voluntarily established health insurance plans in private industry, i.e. group employer plans, fall under the requirements set by the Employee Retirement Income Security Act of 1974 (ERISA). Under this federal law, health insurance companies such as Anthem must provide their plan participants with plan information including the funding of the plan and who has fiduciary responsibilities.
Insurance companies are also mandated by this law to establish a grievance and appeals process for their participants. The law also provides plan participants the right to sue for benefits and breaches of fiduciary duty.
Health plans and health insurers that are not governed by ERISA in California are subject to various laws in the California Insurance Code and the California Health and Safety Code, such as the Knox-Keene act.
Those who work with a Los Angeles Anthem health insurance denial appeals lawyer may be able to increase their chances of acceptance for their claim or appeal.
Let a Los Angeles Anthem Health Insurance Denial Appeals Attorney Help
If you need help dealing with a health insurance issue, consult with an attorney. A well-versed attorney is familiar with the games insurance companies such as Anthem can play and have experience getting policyholders the coverage they need and deserve.
A compassionate lawyer’s goal is to get Anthem to take steps towards reviewing your appeal and possibly getting them to accept your claim. Contact a Los Angeles Anthem health insurance denial appeals lawyer today to learn more about how they can help you.