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Bad Faith Insurance: Anthem Blue Cross of California

Insurance companies are supposed to be there for us in our most vulnerable moments.

Unfortunately, many people have discovered that their insurer cannot be relied upon — even if they pay their premiums faithfully.

This sad realization doesn’t just apply to small, fly-by-night insurance companies with dubious reputations. Even some of the world’s largest insurers have acted in bad faith.

One example is Anthem Blue Cross of California. As the largest personal insurance provider in the state, countless Californians rely on Anthem to cover them in case of significant losses.

In most cases, the insurer meets this obligation, However, on occasion the insurer’s desire to control costs results in bad policy decisions that deny people what they are owed.

What is Bad Faith Insurance?

Occasionally Anthem Blue Cross or other insurers will issue denials of claims that do not withstand scrutiny or seem to violate the basic principles of common sense. Such denials, which may include partial coverage when full coverage is owed, can not only leave policyholders stuck with large bills, they can also prevent them from receiving necessary medical treatment.

Many of these denials fall into the same basic categories:

  • Insurance carriers will sometimes try to claim that a medically needed procedure is cosmetic, and deny it on those terms.
  • They may also deny claims for treatment of payment for procedures deemed experimental.
  • They may deny specialist care or access to services such as MRIs. For example, some insurers make sufferers of back injuries wait 30 days for an MRI to ensure the pain does not resolve on its own.

Anthem’s Track Record

Anthem in particular has a record of acting in bad faith by denying claims based on an overly broad interpretation of what is experimental or a very narrow definition of what is medically necessary.

Anthem has also drawn criticism for a policy that denied coverage of ER visits if the reason for the visit was later deemed to be not sufficiently serious for the ER. For people who suffer symptoms that are not easy to diagnose (such as chest or abdominal pain), this policy forced them to make snap decisions about going to the ER based on financial considerations.

Anthem has also come under fire for refusing to cover powerful new drugs capable of curing life-threatening illness if the patient’s case of that illness was not deemed to be sufficiently advanced.

What to Do Next?

If you feel you’ve been a victim of Anthem’s bad faith practices, we urge you to contact us immediately. Bad faith insurance cases can be quite complex, so it’s imperative to work with a law firm specializing in this form of litigation.

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