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California Wildfire Bad Faith Insurance Denial Lawsuits Get New Life

California Wildfire Bad Faith Insurance Denial Lawsuits Get New Life March 1, 2021. By Anne Wallace.
San Francisco, CA In May 2020, the California Court of Appeal for the First Appellate District reversed the trial court’s grant of summary judgment to State Farm Insurance Co. Leonard and Patricia Fadeeff challenged the insurer’s denial of their claim for damage to their home in the 2015 Valley Fire. Fadeeff v. State Farm continues to be a seminal case in California bad faith insurance denial lawsuits.
Read [ California Wildfire Bad Faith Insurance Denial Lawsuits Get New Life ]

Denied Insurance Coverage for Proton Beam Therapy

Denied Insurance Coverage for Proton Beam Therapy February 24, 2021. By Jane Mundy.
Santa Clara, CA Proton beam radiation therapy (PBRT) is purportedly a safer and more effective cancer treatment than x-ray or photon-based treatments and less invasive than surgery, but some insurance companies deny coverage, which has led to bad faith insurance lawsuits.
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Prosthetic Denial Lawsuits Filed against UnitedHealth Group and Anthem under ERISA

Prosthetic Denial Lawsuits Filed against UnitedHealth Group and Anthem under ERISA September 24, 2018. By Jane Mundy.
Santa Clara, CA: Prosthetics with a variety of microprocessors are the new “wearable technology” and they’re making headlines. Companies have designed the devices with
Read [ Prosthetic Denial Lawsuits Filed against UnitedHealth Group and Anthem under ERISA ]

Amputees Fighting for Insurance Coverage Get Tips from Blue Cross Antitrust Lawsuit

Amputees Fighting for Insurance Coverage Get Tips from Blue Cross Antitrust Lawsuit September 20, 2018. By Anne Wallace.
Wilmington, DE As amputees fight for insurance coverage for advanced, microprocessor- assisted prostheses, it can help to look at other insurance lawsuits that describe a similar pattern of claims denials.

LifeWatch Services v. Highmark is actually an antitrust lawsuit dealing with telemetry cardiac monitors. Nonetheless, a recent opinion in the Third Circuit, describes a pattern of denials that amputees seeking coverage for “smart prostheses” will find strikingly familiar. The heart monitors, like the microprocessor-powered feet and legs are rejected as “not medically necessary” or “investigational.” The denials, sometimes in exactly the same language, are consistent across the Blue Cross Blue Shield network of insurers. Why is this so?

LifeWatch offers two strategic thoughts for amputees fighting for insurance coverage:

Read [ Amputees Fighting for Insurance Coverage Get Tips from Blue Cross Antitrust Lawsuit ]

Dentist Claims Injury, Unum Claims Sickness to Deny

Dentist Claims Injury, Unum Claims Sickness to Deny September 13, 2018. By Jane Mundy.
San Diego, CA: A dental surgeon has filed a bad faith lawsuit against Unum, or First Unum after the giant insurer denied his long term disability benefits claiming his injury is a sickness. The Unum lawsuit claims that Unum denied the dentist his rightful benefits to protect their own interests.
Read [ Dentist Claims Injury, Unum Claims Sickness to Deny ]

Amputees’ Fight for Insurance Coverage Focuses on ‘Medical Necessity’ of Microprocessor Prosthetics

Amputees’ Fight for Insurance Coverage Focuses on ‘Medical Necessity’ of Microprocessor Prosthetics September 4, 2018. By Anne Wallace.
Washington, DC Lucky to live, unlucky to lose a foot or a leg, survivors of the Boston Marathon bombing soon found themselves facing the harsh truth of inadequate insurance coverage for their prosthetic care. Years on, the good news is that microprocessor-enhanced artificial limbs have gotten better. The bad news is that insurance companies like Anthem and United Healthcare still balk at paying for them. Insurance lawsuits since then have taken particular aim at the internal review standards insurers use to determine whether a medical treatment or device is “medically necessary.” The standards do not line up with what amputees need most and what these modern devices can really do. Cost cutting vs. good health – it’s the match of the century.

Fear of Falling

Read [ Amputees’ Fight for Insurance Coverage Focuses on ‘Medical Necessity’ of Microprocessor Prosthetics ]

Lawsuits Brewing over Insurance Denials for “Smart” Prostheses

Lawsuits Brewing over Insurance Denials for “Smart” Prostheses August 21, 2018. By Anne Wallace.
Los Angeles, CA In California and other states, amputees are denied insurance coverage for modern prostheses. These legs and ankles are hugely better than the old titanium alloy stilts because of their microprocessors. Lt. Dan was glad to stand with his bride, but imagine running up the stairs or dancing at a Gump-ish wedding. Nonetheless, Anthem, United Healthcare and other insurers plead shock, confusion, and a general lack of evidence when asked to pay for the more modern prosthetics. The ensuing insurance lawsuits have taken aim at the insurers’ claims that the advanced prostheses are not medically necessary or still experimental.
Read [ Lawsuits Brewing over Insurance Denials for “Smart” Prostheses ]

Anthem Denials of Emergency Room CT Scans and MRIs; Patients Sent to Clinics

Anthem Denials of Emergency Room CT Scans and MRIs; Patients Sent to Clinics August 6, 2018. By Anne Wallace.
Washington, DC In July 2018, the American College of Emergency Physicians filed an insurance lawsuit against Anthem Blue Cross Blue Shield over the insurer’s new policy of denying emergency room coverage after the fact. As a subpart of the strategy, Anthem refuses claims for in-hospital CT scans and MRIs ordered in the course of emergency diagnosis and treatment. The lawsuit focuses on the harm the policy does to patients. But it also shines a light on the damage that Anthem’s plan does to hospitals and the wider healthcare system.
Read [ Anthem Denials of Emergency Room CT Scans and MRIs; Patients Sent to Clinics ]

Sen. McCaskill Probes Anthem Emergency Room Coverage Denials

Sen. McCaskill Probes Anthem Emergency Room Coverage Denials July 28, 2018. By Anne Wallace.
Washington, DC On July 17, 2018 Sen. Claire McCaskill’s office released a report detailing the results of an investigation into Anthem Blue Cross Blue Shield’s efforts to cut costs by denying emergency room coverage after the fact. Many of these insurance claim denials were eventually reversed. But Anthem may have succeeded in its overall goal of dissuading patients from seeking emergency care. A bad faith insurance lawsuit filed with California’s Department of Managed Health Care further shows how a combination of intimidation and delay can wear patients down. The good news, though, is that claimants who persist often win.
Read [ Sen. McCaskill Probes Anthem Emergency Room Coverage Denials ]

Anthem Refuses to Cover Emergency Room Care After the Fact

Anthem Refuses to Cover Emergency Room Care After the Fact July 18, 2018. By Anne Wallace.
Sacramento, CA Anthem Blue Cross Blue Shield denies emergency room coverage for patients whose symptoms later prove to have been non-life threatening. This has been a long-standing practice, but it is now official policy in six states. Are California patients protected under California insurance law?
Read [ Anthem Refuses to Cover Emergency Room Care After the Fact ]

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