Los Angeles Anthem Health Insurance Denial Appeals Process

Anyone who has ever received a medical bill knows the importance and significance of having health insurance. However, even with health insurance you may find yourself facing obscene medical bills, or you may not be able to receive the proper treatment because your health insurance claim was denied.

If Anthem denies your request for health insurance or your health insurance claim, it is important to know that you have the right to appeal Anthem’s decision. In addition, you have the right to have your health insurance denial reviewed by the California Department Managed Healthcare.

If Anthem denied you or a loved one health insurance coverage, contact a skilled health insurance denial lawyer today to learn how to begin the Los Angeles Anthem health insurance denial appeals process.

Beginning an Appeal

After a health insurance coverage denial by Anthem, the first step is to follow the company’s internal appeals process and appeal the decision directly with Anthem. In some cases, insured individuals find that their claim was denied because of a simple error on their part or the insurance company’s fault, and an internal review may quickly resolve this error. In other circumstances, it might be not worth it to consider an internal appeal but instead to proceed directly with litigation. This option may be available for someone with a non-ERISA health plan.

Collecting Documentation for an Insurance Appeal

Collecting documentation before beginning a health insurance appeal is one of the most effective ways a policyholder can increase their odds of receiving the health coverage they need. To begin, they should collect documentation from their doctor that provides objective medical evidence to support a claim. This can include copies of their medical records, independent research on a procedure or a course of medication, and in some cases even a letter from a treating physician.

In addition, it is also important to collect documentation from Anthem. Policyholders should request information on their particular health insurance plan, so they can understand what their plan covers. In addition, they should collect documentation detailing why their claim was denied. This may provide insight into Anthem’s decision and can help strengthen an appeal.

Finally, rejected policyholders should collect documentation on the specific person who denied their claim, including their name, title, and credentials. Collected information should also include whether Anthem consulted with medical experts before deciding on the claim, as well as the medical criteria Anthem used to review it.

Filing an External Appeal

Some individuals may find that an internal appeal results in Anthem changing their decision, thereby allowing them to receive medical care and treatment. However, if Anthem does not reverse their decision after an internal appeal, policyholders have the right to file an external appeal. To file an external appeal, it is important to make note of several key factors in the associated process.

Time Limitations

An individual has the right under California law to file an appeal with the Department of Managed Health Care (DMHC) or the California Department of Insurance (DOI) within six months.

Requesting an External Appeal

To request an external appeal, a policyholder must fill out an online application with the DMHC or the DOI. Generally, an applicant must exhaust the internal review process provided by Anthem before they can request an external review. However, in the event that a medical procedure is urgent, a person has the right to file for an external review immediately.

Providing Documentation

In order to support an external appeal, it is important to provide a copy of any insurance card, copies of the denials letters, copies of internal medical reviews, any materials gathered prior to filing an appeal, and a copy of the health insurance policy, as well as any correspondence from Anthem.

The Benefits of Seeking Professional Help with the Los Angeles Health Insurance Denial Appeals Process

Working with a health insurance company such as Anthem can be incredibly frustrating and confusing, particularly if you had your claim denied. An experienced lawyer could help guide you through the appeals process by ensuring you have all the appropriate documentation for an internal appeal, as well as an external appeal.

In addition, an attorney could review a health insurance plan and draft an aggressive and poignant appeals letter which could be an invaluable resource in an appeal hearing. Call today to learn more and get started on your case.

Los Angeles Anthem Health Insurance Denial Appeals Lawyer