Los Angeles Anthem Denial and California Law

Many individuals and families rely heavily on their health care insurance. They rely on their insurance so much so that having even a small claim denied can lead to significant financial struggles. If you can relate to this and have received a denial for a health insurance claim, you may be wondering the relationship between your Los Angeles Anthem denial and California law.

The good news is that insurance companies in California cannot just make up their own rules as they go along. They are beholden to both federal and state laws. If you believe your health insurance company is illegally denying a claim, you should contact a well-versed insurance denial attorney.

Insurance Laws Regarding Denials in Los Angeles

According to the Doctor-Patient Rights Project, a commissioned nationwide survey of Americans revealed that 24 percent were denied an insurance claim. Sometimes these denials arise out of illegal actions or policies within the health insurance company.

California law and Los Angeles Anthem denials are closely intertwined. California health insurance companies are also beholden to the federal Affordable Care Act (ACA) laws. These laws are meant to protect insured parties from being taken advantage of by big insurance companies. As per California insurance laws, health insurance companies must do the following:

  • Adopt and implement reasonable standards for the prompt investigation and processing of claims arising under insurance policies
  • Adhere to the applicable standards of the California Health and Safety Code and to the California Code of Regulations Fair Claims Settlement Practice Regulations
  • Accept or deny a claim within 40 calendar days of receiving it
  • Formally deny a claim in writing and include the basis for denial and reference any laws that may be involved

Whenever a claim is denied it may be best to consult an experienced attorney who understands Los Angeles Anthem denials and California law. They can fully investigate the reasons behind the denial to determine whether it was valid. Regardless of the reason for the denial, the attorney can help the policyholder determine a strategy for appealing to get the coverage they need.

Anthem Policies are Contracts

In addition to the ACA and California Insurance Code, healthcare insurance companies in this state must also be mindful of California contract law. This is because insurance policies are contracts in the eyes of the law. When a company breaches California contract law, they can be held liable by a practiced attorney.

Learn More About a Los Angeles Anthem Denial and California Law

You cannot be protected by California insurance laws if you do not hold your insurance carrier responsible. One way to hold them responsible is to work with a qualified insurance attorney. An insurance denial attorney is familiar with Los Angeles Anthem denials and California laws and can take action that may be able to get you the coverage you are entitled to.

They know the tactics Anthem and other California health insurance companies will use in order to prevent your claim from being paid. They can spot illegal and unfair practices and hold them accountable. Call today to get the protection that you deserve under California insurance laws.