Los Angeles Anthem Lack of Eligibility Denial Lawyer

When you purchase and pay for a health insurance policy, you expect that when you need to use your policy your expenses will be covered according to your plan. However, each year many people are surprised when they find out that their health insurance claim has been denied for a lack of eligibility.

If this happened to you, you may be worried about paying your medical bills, feel overwhelmed, or even feel betrayed by your insurance company. If you are ready to take action, a Los Angeles Anthem lack of eligibility denial lawyer can help you. By working to thoroughly understand the policy and the reasons behind the denial, a detail-oriented health insurance denial lawyer can help you fight for the coverage you are entitled to.

Who is Not Eligible for Coverage from Anthem?

The Affordable Care Act (ACA) has extended health care coverage to many Americans who previously could not afford or receive coverage. However, insurance companies are in the business to make money. Therefore, they are inherently in the business of denying claims. Often, they look for ways to deny claims, even if they are legitimate. One of the most common reasons for claim denials is that the insured is not eligible for coverage. This can apply when:

  • The insured has not paid or is late in paying their policy premiums
  • The claim involves the result of activities not covered by the policy such as skydiving or treatments and services that are explicitly excluded under the terms of the health plan
  • The claim is for a treatment that the insurer does not find to be medically necessary
  • The claim is for a treatment or service that the insurer considers to be experimental or investigational
  • The claim involves a pre-existing condition
  • The claim was for a date of service prior to the beginning of coverage or after coverage ended

Even if a claimant is denied coverage for ineligibility, the insurance company may not have properly informed them. For example, the insurance company must provide the insured with a grace period in which to make their payment before the policy is canceled for non-payment. If a policy was canceled without such a grace period or notice, the claimant may be entitled to coverage or compensation under the law.

It is important to discuss insurance coverage denials for lack of eligibility with an experienced Los Angeles Anthem lack of eligibility denial attorney. Even when it seems that the insurance company has acted according to their policy, the claimant still has rights and can still appeal the decision.

Insurance Policies as Contracts in Los Angeles

A health insurance policy is essentially a contract between the health insurance carrier and the insured. While a judge or a jury cannot force Anthem to pay a claim, they can enforce California contract laws.

If the policy does not list the specific reason a person was deemed ineligible for coverage, Anthem may be in breach of their own contract. A Los Angeles Anthem lack of eligibility denial lawyer can help individuals hold Anthem accountable.

Getting Help from a Los Angeles Anthem Lack of Eligibility Denial Attorney

According to the California Nurses Association, approximately 25 percent of all health insurance claims are denied. These denials can come as a shock and stir up a lot of emotions and worry. Sometimes, these denials are also wrong.

A compassionate attorney is here to help. If you were denied coverage based on eligibility, a Los Angeles Anthem lack of eligibility denial lawyer from can provide you with legal assistance to fight the denial. Learn more by calling today to set up a free consultation.