Los Angeles Anthem Blue Cross of California Health Insurance Denial Lawyer 

Anthem Blue Cross is one of the largest health insurers in California. With the recent expansion of the State’s Health Exchange, more people than ever rely on their policies to cover medical expenses that can range from simple check-ups to emergency surgeries and extensive rehabilitation services. Often, insurance policies cover all or most of the payments for these services. However, sometimes, the insurance company denies payment for treatment.

The State of California provides a means for individuals who had their claims denied to appeal the decision. The law requires that all insurers maintain an internal appeals process, but when this fails, there are several other options to appeal a claim.

A Los Angeles Anthem Blue Cross of California health insurance denial lawyer can help you appeal a denial of coverage. Whether this denial involves a denial of treatment altogether or a refusal to reimburse an already received treatment, an experienced health insurance denial attorney can help demand enforcement of insurance policies.

Reasons Anthem Blue Cross of California May Deny a Claim

Insurance companies such as Anthem Blue Cross of California have many reasons to deny claims or treatment. Unfortunately, the main reason is usually profit. Insurance companies make their profits by denying claims that they consider questionable. However, the explanations they give usually cite other issues. Common reasons they give for denial include:

  • The treatment is provided by an out-of-network doctor
  • The treatment is not medically necessary
  • The procedure is elective and not essential to a person’s health
  • The subscriber did not complete their application in a correct or complete manner

Regardless of the reason why the company denies the coverage, they must provide a written explanation that includes information about how to appeal the denial.

Appealing an Anthem Blue Cross Insurance Denial

The State of California requires that all insurers maintain their own internal appeals process for coverage denials. Anthem gives subscribers 60 days from the notice of their decision to file an appeal. The person can either independently file the appeal or someone can file it on their behalf. If they appoint a representative to file the appeal, they must fill out the necessary paperwork giving the representative authority to act on their behalf.

Unfortunately, these appeals are rarely successful as the people who denied the claim the first time are usually the ones who process the appeal. However, if the insurer denies the appeal, the individual may have the right to take the appeal to an independent third-party for additional review, but this is not necessarily the best path. In some cases, it may make more sense to take the case directly to civil court instead.

Health insurance policies are contracts between subscribers and the insurance company and the court may consider the denial of coverage a breach of contract on the part of the insurance company. If that is the case, they may order the insurance company to cover costs. A Los Angeles Anthem Blue Cross health insurance denial lawyer can evaluate the claim and help the person determine the best way to proceed.

How a Los Angeles Anthem Blue Cross of California Health Insurance Denial Attorney Can Help

People expect that their health insurance will provide necessary payments for medical emergencies or will provide coverage when they fall ill. However, insurance companies such as Anthem Blue Cross of California utilize many methods to deny coverage and increase their profits.

A Los Angeles Anthem Blue Cross of California health insurance denial lawyer could help fight back. They can file appeals with Anthem’s internal processes, create cases before the state’s review board, or even take cases to court to enforce a policy. If Anthem Blue Cross denied your health insurance claim, contact our experienced attorneys today to find out how we may be able to help you.