Health Insurance
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California Health Insurance

Denied health insurance coverage?

Residents of California can be denied health insurance coverage for a variety of reasons. You may be denied coverage after reaching a maximum coverage amount due to an illness or treatment. You may be denied because of a lack of continued eligibility or even a change in job position that renders you ineligible for sustained coverage. Whatever the reason, being denied coverage can make paying for a long term illness or condition next to impossible for many Californians.

Your health insurance claim in California can be denied for a myriad of reasons. One of the most common reasons given, however, is labeled as "material misrepresentation." This is a term used whenever an insurance company deems that you have misrepresented some fact or facts on your initial or renewal application. Under California law, this error has to be something that is significant enough that it would have led the insurer to refuse your policy originally.

Typical examples of material misrepresentation include unreported or underrepresented levels of tobacco or drug use, the exclusion of a chronic medical condition, dangerous hobbies, piloting, skydiving, or a history of reckless driving.

You cannot be denied for simple misstatements, however. For example, if you say you have green eyes on your application and the insurance company lists them as "hazel," your claim cannot be denied.

What to Do When You've Been Denied Health Insurance Coverage in California

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. There is no reason to be intimidated by your health insurance company with us on your side.

California Health Insurance Appeals Are Our Specialty

If you've already attempted the appeals process with poor results or are simply not sure what to do after a denial, it pays to hire a lawyer. Even if you have already filed an appeal, it may not be too late. Legal experts 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.

Over 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, and the legal system now provides an outlet for regular folks to take on huge insurers--and win.

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.

California Health Insurance Laws Can Work for You

At Kantor & Kantor, LLP, we can help you use California health 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 under the law

Contact Our California Firm

At Kantor & Kantor, LLP, we firmly believe that you shouldn't have to fight the insurance company on your own. We've done court battle with major insurers in California and will not back down from any viable case. We will work tirelessly for you.

To begin, we simply ask that you come in for a consultation. We've worked with clients on a myriad of cases, ranging from health insurance denials to the denial of long term care benefits. At this critical time in your life, we know how important it is that you have reliable coverage.

Speak with us at (877) 220-0556 or via email.

Client Testimonials

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