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Was your health insurance claim denied?

California Health Insurance Claims Denial Lawyers

Denied Health Insurance Coverage? Call Our Team

Health insurance companies are often tempted to deny claims filed by patients in need – and the denials don’t always follow the rules. The reasons given are many, including that coverage is not provided in the policy, that the services were “not medically necessary” or were not “authorized,” or perhaps the insurer will characterize the treatments as “experimental.” Sometimes, no clear or valid reason is given at all, and the insurer hopes the claimant accepts the loss and moves on.

Our California health insurance claim attorneys from Kantor & Kantor have seen all of these reasons used to deny coverage, as well as dozens of other reasons. While there are times when an insurer is correct in denying a claim, we have found such circumstances to be few and far between. Instead, the common result is that deserving people are denied their health insurance benefits when they need them the most.

Our attorneys would be honored to help you through a dispute with the following and more:

  • Anthem Blue Cross
  • Blue Shield
  • Aetna
  • Health Net
  • Kaiser
  • Met Life

For over 20 years, we have been helping people deal with the roadblocks put up by insurance companies. Call (877) 783-8686 today.

What is Material Misrepresentation

As mentioned, there are many ways and reasons for a health insurance company to deny your claim. One of the most common reasons given, however, is labeled as "material misrepresentation." This term is used if your insurance company deems that you have misrepresented a fact or facts on your initial or renewal application. Under California law, this error has to be significant enough that it would have led the insurer to refuse your policy originally.

Examples of material misrepresentation include:

  • Underreported levels of tobacco use
  • Undisclosed drug use
  • Exclusion of chronic medical conditions
  • No mention of dangerous hobbies

Health insurance companies looking to deny a claim will sometimes say “material misrepresentation” without backing up their meaning in hopes that the vagueness will suffice. We are here to tell them that it does not. In the past, we have challenged material misrepresentation statements from insurers after finding that they involved something as innocuous as a claimant saying they had green eyes when they meant brown.

What to Do After a Health Insurance Denial in California

If you've already attempted the appeals process with poor results or are simply not sure what to do after a denial, please speak with our lawyers soon. Even if you have already filed an appeal, it may not be too late to turn things around. We can help guide you in the right direction to ensure that you get the money you deserve for a health insurance claim. California law limits the amount of time you have to appeal a health insurance claim denial, so you have to move quickly in order to get the money that is owed to you.

As a highly experienced and industry-respected law firm, our practice is the logical choice when you've been denied health insurance coverage in California. We've dealt with all types of denial cases, and we can sort out the details of yours to present a solid case on your behalf. Across the last several decades, we at Kantor & Kantor, LLP have been a leading source of legal aid for health insurance appeals in California. We've helped myriad clients overturn decisions that were made because of poor record-keeping, billing mistakes, or human error, and we can do the same for you.

California Health Insurance Laws

Recent changes in the California health insurance laws have made it much easier for claimants to get approval for the medical treatments they require. For example, California residents can now legally sue HMOs and other health insurance providers after being denied coverage for vital treatments. According to state laws, these companies have to be accountable for denials.

Basically, the law requires HMOs and other health insurance providers in California to give you the right to a second opinion. Oftentimes, this may require that you go outside of your HMO network for proper treatment. Under old laws, you would be responsible for all or most of your treatment costs outside of your network provider. However, new laws allow you to sue your HMO to cover these costs when medically necessary. Even if you've been denied, you can legally obtain reimbursement in many cases, and we can guide you if you need help.

Contact Our California Health Claims Denial Lawyers

You shouldn't have to fight your insurance company on your own. Trust in our attorneys from Kantor & Kantor & Kantor, LLP, who have done court battle with major insurers in California and will not back down.

We can help you utilize insurance laws to:

  • Fight a California HMO/health insurance provider for coverage outside your network
  • Dispute denied benefits due to material misrepresentation claims
  • Investigate your case to find failures on the part of your HMO to give you adequate care

To begin working with us, we simply ask that you come in for a consultation with our friendly and helpful staff members. It is our goal to make your life easier by providing legal representation that thinks of everything and is ready for anything.

Contact us online or call (877) 783-8686 to get more information.

For over 20 years, we have been helping people deal with the roadblocks put up by insurance companies, and more important, helping them obtain the insurance benefits they are entitled to.

Get in touch with us today for a free consultation.

What Sets Us Apart?

  • Free Case Consultations Provided
  • 160+ Years' Collective Experience
  • Thousands Of Cases Successfully Handled
  • You Don't Pay Us Unless We Recover Your Claim
  • Selected For Inclusion In The List Of Super Lawyers®

Client Testimonials

  • First of all, I want to express my extreme gratitude for probably saving my daughter's life.

    “First of all, I want to express my extreme gratitude for probably saving my daughter's life. By staying in treatment, the improvement is remarkable. She had been in eating disorder facilities many times, and treatment had been interrupted repeatedly by Anthem Blue Cross's denying benefits. Many of the health professionals were telling me that maybe my daughter was a hopeless case. You both gave me hope. She is still struggling with some residual issues around eating, but the change in her attitude, her ability to assess her own recovery, and her wish to live instead of to die, is evident in her life. Now she is back in school, after years of having her education disrupted by the eating disorder. She goes places with friends, and even goes out to restaurants for fun! This year marked the first holiday season for many years, when she had not been in a treatment facility. Other people gave up and you didn't. I can't thank you enough. You took the action that was necessary to keep my daughter in treatment long enough for it to work.”

    Anonymous

  • I've already mentioned your firm to my family and friends and how wonderful you have been treating me.

    “I've already mentioned your firm to my family and friends and how wonderful you have been treating me. Hopefully I will not ever have the need to refer someone to you because that would mean they would be in a similar situation as myself. But, if that were to ever happen, I would absolutely refer them to your company.”

    Linda P.

  • You are the light in the darkness for all of us.

    “Lisa- You are the light in the darkness for all of us in the eating disorder community. I believe that you were born to take on these challenges.”

    Pam S.

  • Thank you for all of your hard work, support and belief in our case.

    “Hi Elizabeth - You have been such an important part of my and Jennifer's past year, and I want to send you a note to wish you a wonderful holiday. Thank you for all of your hard work, support and belief in our case. Thank you seems like two small words and not enough, but they are heartfelt and mean so much.”

    J.H.

  • Truly outstanding in every way!

    “Both Glenn Kantor and his associate attorney Brent Brehm are truly experts in the field of disability law. They handled a complex individual disability policy issue for me. Their knowledge of the law, coupled with their experience, resources, and tactical skills, helped me obtain results that exceeded my expectations. Truly outstanding in every way!”

    Anonymous