Gianelli & Morris is a California law firm that specializes in representing policyholders against insurance denials and claims. It focuses on cases involving health insurance, life insurance, disability insurance, and commercial claim denials.

Gianelli & Morris

Gianelli &amp; Morris | 35 followers on LinkedIn. Fighting for California policyholders since 1979 | Gianelli &amp; Morris is a leading California law firm concentrating in insurance denials and bad faith. When insurance policyholders have their claims denied or can’t get the coverage they need, they bring their case to Gianelli &amp; Morris. We take on the biggest cases and get results.

Attorney at Gianelli & Morris, ALC

Howard Loring Rose

Partner at Gianelli & Morris

Robert S. Gianelli

Attorney at Gianelli & Morris

Timothy James Morris

When insurers fail to resolve payment disputes with healthcare providers, it impacts the ability of doctors to provider quality services to patients. The California Department of Managed Health Care agrees, and recently fined two Anthem Blue Cross health plans $8.5 million for their failure to resolve disputes in a timely manner required by law. Learn about these recent DMHC fines and others that continue to be levied against Anthem Blue Cross. https://lnkd.in/gvjY-jtc

Automation is happening everywhere, including in the processing of insurance claims. In this case, that’s not always a good thing. California law requires human beings to review claims for medical necessity, which is not necessarily something AI and algorithms can do. Learn the many ways claim automation is not in your best interest. https://lnkd.in/g6S42Bkm

If your insurance company tells you that you don’t need to get an attorney, they’ve committed an unfair practice in the business of insurance under California Insurance Code 790.03. Learn about your right to an attorney for help with insurance claims in California. https://lnkd.in/g94Y5aXQ

Did your insurer deny your request for treatment because it wasn’t “medically necessary,” or did they tell you a provider was in-network when they weren’t? Did they misrepresent the exclusions in your life insurance policy or misstate the requirements needed to submit a claim? These are unfair practices in insurance and potential signs of bad faith. Learn about insurance companies misrepresenting facts or policy provisions in California. https://lnkd.in/gk7Vbt9U

If your insurer fails to communicate with you as required by law, they may be acting in bad faith and attempting to delay or deny your claim unreasonably. Find out when they are violating the law and what you can do about it. Learn about an insurer’s duty to communicate with the insured under California law. https://lnkd.in/gFpw3bcw

Insurance companies have a bad habit of making blanket exclusions of certain treatments or procedures, so they don’t even consider a policyholder’s request or medical need. That’s a violation of California insurance law and evidence of bad faith. Learn about the consequences of an insurance company failing to investigate a claim. https://lnkd.in/dHwagaKj

For a long time, Anthem Blue Cross relied on one of its Clinical Guidelines to deny treatments related to sex reassignment surgery and to treat gender dysphoria. After the state insurance regulator patiently explained to Anthem why this is wrong (and fined them nearly half a million dollars), the insurance company has promised to change its ways. Learn about Anthem’s $450,000 penalty for issuing blanket exclusions of procedures without evaluating each request for medical necessity as required by law. https://lnkd.in/dvQeZ29t

California law requires insurance companies to have grievance policies in place for customers. Insurers must adequately consider grievances, respond to them and rectify them in a reasonable time. Month after month, year after year, the California state regulator shows how bad insurance companies are at following the law. Learn how Anthem Blue Cross got hit with $162,000 in penalties for grievance violations in August. https://lnkd.in/g6cD-BfQ

If your insurance claim is denied, the insurance company is required by law to provide a reasonable explanation of the basis relied on in the policy for denying the claim. Failure to do so is an “unfair and deceptive act,” also known as insurance bad faith. Learn how the failure to explain a claim denial is treated under California insurance law. https://lnkd.in/giNCDven

Here’s one of the most frustrating aspects of dealing with insurance companies: when they keep requesting the same documentation in different ways. Are they just being inefficient, or is this a bad-faith insurance tactic designed to delay your claim? Learn about repeated requests for documentation and why this is a prohibited practice under California insurance law. https://lnkd.in/gEjisbvd

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Gianelli & Morris