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Dawson and Rosenthal
Dawson and Rosenthal

San Diego Health Insurance Bad Faith

Insurance bad faith, or insurance fraud, occurs when an insurance company fails to pay a settlement as promised in the policy. One of the worst types of insurance bad faith is in health insurance, where insurers take advantage of those who are suffering from medical crises. If you’ve experienced health insurance bad faith in San Diego or the surrounding area, talk to one of our attorneys.

Most insurance policies are safety nets, but health insurance is something people rely on to afford the exorbitant costs of medical care. When suffering a health crisis – either theirs or a family member’s, the last thing clients want to face is an insurance company that deals with them unfairly and won’t pay for care or won’t pay the proper amounts for care.

San Diego Health Insurance Laws

In San Diego, the California Department of Insurance regulates and monitors health insurance plans. The only exceptions to this are health maintenance organizations (HMOs), managed care plans, and self-insured health plans. The type of health insurance determines the type of treatment and care available to a patient.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects consumers’ medical information against insurance fraud. This is a federal law and encompasses all policies purchased in San Diego. If a health insurance company is treating you unfairly, the law can protect you and ensure the company pays for your healthcare.

How to File a Health Insurance Claim

To file a health insurance claim, contact your insurance provider. Most insurance companies have an online option or a phone number to call. The agent you speak with should be able to walk you through the step-by-step process of filing your claim and getting the appropriate payout. Be sure to have all the documentation you may need in front of you during your phone call, including medical bills, prescription drug needs, and your insurance policies.

Health Insurance Bad Faith Laws in California

A denied claim or delayed payment may be grounds for a health insurance bad faith claim under the protection of the insurance bad faith laws in California. Consumers purchase insurance policies with good faith, and the laws clearly state that both parties will follow the policy. Insurance companies have a duty to fully investigate a claim before denying it.

Examples of Health Insurance Bad Faith

Many types of health insurance bad faith claims exist. Some are specific to certain types of health insurance, while others cover different fields. Some examples of health insurance bad faith might include:

  • Inadequate investigation into a claim before denial.
  • A delay in handling a claim for a unique reason.
  • An unreasonable settlement option.
  • Delaying payment of a claim indefinitely.
  • Refusal to pay a reasonable claim.
  • Trying to change parts of an already established insurance policy.
  • Denying a claim for experimental procedures.
  • Denying a claim for no reason at all.
  • Refusing requests for documentation of a claim.

What to Do After Suspecting Health Insurance Bad Faith

If you suspect health insurance bad faith has happened to you, file a claim with the California Department of Insurance. This lengthy process requires a great deal of knowledge, so having an attorney file on your behalf may mean the difference between a successful claim and another rejection. Lawyers who specialize in health insurance bad faith know exactly how to handle a claim and how to get the best results.

Find Help for Bad Faith Insurance in San Diego

If you or a loved one is experiencing a health insurance bad faith, call our office today. We have been handling bad faith health insurance claims for over 50 years and only take on a few cases at a time to ensure your case gets the attention it deserves.