Los Angeles Anthem Out-of-Network Coverage Denial Lawyer

Perhaps you recently made the decision to seek medical care with an out-of-network provider through your Anthem health insurance coverage. You may even have known that using a provider who is not in-network with your insurance company possibly meant paying more for the services or you might not have had a choice because you were seeking emergency care. What you may not have expected was to have your out-of-network claim completely denied by Anthem.

Alternately, it is possible that Anthem told you that a certain provider was in-network and yet informed you after the medical services were rendered that, in fact, they were not. You might even have sought emergency medical care with the only facility that was close to your location, only to have the claim denied because the hospital was out-of-network.

Regardless of the specific reason for your denial, you have the right to appeal that decision if you so choose. If you were denied coverage that you believe you are entitled to, an Los Angeles Anthem out-of-network coverage denial lawyer may be able to help you.

Healthcare Out-of-Network

A Consumers Union survey conducted in 2015 found that almost one in four California patients who went to a healthcare facility or had a surgical procedure in the past two years received bills with out‐of‐network rates when they believed their provider was in‐network. This often happens when a patient receives care that involves procedures or testing.

For example, a policyholder may ensure that their hospital and doctor are in-network with Anthem, only to find out that the anesthesiologist or pathologist that also provided services to them were out-of-network. Patients do not get to choose these types of providers; therefore, they are effectively forced into out-of-network care. Prior to a new law that went into effect in July of 2017, there was not much they could do about this.

Out-of-Network Coverage Laws

According to this new legislation, though, additional protections are provided to California consumers who have individual health insurance plans that are under the authority of the state Department of Managed Health Care (DMHC) or the state Department of Insurance. This includes approximately 70 percent of private health insurance policies in California, according to the California Health Care Foundation.

In essence, the law makes it so that providers such as anesthesiologists cannot balance-bill a patient for out-of-network services if the services were rendered at an in-network facility. Instead, the patient would be billed as if the anesthesiologist was in-network. An Anthem out-of-network coverage denial lawyer in Los Angeles could review a patient’s medical records and billing to determine adherence with the new law.

Get Legal Assistance with Los Angeles Anthem Claims Denials

Like most health insurance subscribers, you trust that your insurance company will pay your claims according to the terms of your policy. However, if you are among the 24 percent of Americans who, according to a survey conducted by the Doctor-Patient Rights Project, have had a claims denial, that trust has likely been broken.

When Anthem denies any type of coverage that they had a contract with you or were otherwise legally mandated to provide, you may have legal recourse. Skilled attorneys who are well-versed in contract and insurance laws are not intimidated by large insurance companies and could stand up for you and your best interests.

An experienced Los Angeles Anthem out-of-network coverage denial lawyer could work on your behalf to get your claim covered. Call today to learn more about how a local attorney may be able to help.