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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

  • I won the appeal.

    “Hi Glenn- This is a very belated thank you for your generous assistance and advice last summer, when I was appealing UBH's decision for my son. I won the appeal, at least for care at the partial hospitalization level (they wouldn't budge on residential, but the facility was accepting the partial care reimbursement for residential treatment). But the appeal was a great moral victory, and I think it's a great thing to have in the record, just in case he needs to go for treatment again. Thanks again for your generous help, I was very grateful for it. Wishing you a most happy Thanksgiving.”

    Terry S.

  • The arguments you made on our behalf at the mediation resulted in a more positive outcome for our case than we could have otherwise expected.

    “We appreciate that you found merit in our case, and that you were both willing and able to be present at the mediation. We believe that the arguments you made in our favor to the mediator were able to influence the outcome towards resolution that we could feel satisfied with. In the end, we believe that your counsel, your support, and the arguments you made on our behalf at the mediation resulted in a more positive outcome for our case than we could have otherwise expected. Throughout you were always professional, but direct and clearly firm on our position. We thank you for your efforts to resolve our dispute to our satisfaction, and wish you continued success.”

    Mara T.

  • 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.

  • 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

  • I am so grateful for all your efforts and I'm sure glad you were on my side fighting for me.

    “Dear Alan - I just wanted to send you a special note of thanks for all your hard work on behalf of me and my case. I am so grateful for all your efforts and I'm sure glad you were on my side fighting for me.”

    Tracy R.