School Staff Hit With Treatment Denials? New Bill Would Force Insurers to Explain
If the health insurance company has denied a claim that you believe should have been paid, it is not the end of the road for you. An Inland Empire insurance claims denial lawyer at Quincey Law is in your corner when you need us.
When you trust an insurance company literally with your health, you have no idea how they may act as a course of business. As a consumer, you should have the right to transparency, so you can make the best possible decisions for you and your family. With that in mind, a proposed law in the California Assembly would force health insurance companies to report a variety of data that would give you a sense of how they do business.
If you believe that your health insurance claim has been wrongfully denied, get legal help from an experienced Rancho Cucamonga health insurance claims denial attorney at Quincey Law. We fight to hold these large companies accountable when they fail in the obligation that they owe you under the terms of your policy.
The Proposed Law Would Mandate Insurance Companies to Be Transparent
As a public school employee, you may have the belief that you receive “better benefits” than the average person who works for a private sector company. However, health insurance companies routinely deny claims, no matter who employs you. This may leave you shocked and angered when the claim that you were counting on to be covered has been denied. The problem is that you may have no idea how the insurance company acts before that time. A proposed bill in the California Legislature would require insurance companies to report certain information about claim denial when they require pre-authorization for treatment.
AB682 is currently pending in the California Assembly. The intent of the bill is to increase transparency to give policyholders a better idea of how each individual insurance company operates. Under the bill, insurance companies would be required to annually report claims data by February 1 of each calendar year and report the information on their website by April 15.
The thought process is that you, as the consumer, should know the metrics of how an individual health insurance company operates, so you can make more informed choices about who you may select for coverage. As a school employee, you are likely offered a menu of companies and coverages from which to choose at open enrollment each year. If the bill becomes law, insurance companies may change how they do business because their practices could be exposed to actual and potential consumers.
What Needs to Be Reported if the Bill Becomes Law
There is a long list of items that a health insurance company would be required to report, including but not limited to the following:
- A list of items and services that require prior authorization.
- The percentage of standard prior authorization requests that were approved, aggregated for all items and services.
- The percentage of standard prior authorization requests that were denied, aggregated for all items and services.
- The percentage of standard prior authorization requests that were approved after appeal, aggregated for all items and services.
In addition, insurance companies would need to report other data that includes the time between the submission of a pre-authorization request and its approval. This requirement covers both standard and expedited reviews. Insurance companies would also be obligated to disclose the percentage of claims that they have paid within 30 days of the time that it was submitted by the provider.
There is a lengthy list of what is required to be reported and how. The bill would require insurance companies to pick up their own costs for aggregating and reporting this data. However, if health insurance companies incur a significant additional cost to comply with the law, they may try to pass these along to you as the consumer in the form of higher premiums.
Of importance, the law would also require insurance companies to report what percentage of policyholders exercise their right to file an appeal of a claim denial. You may be surprised to learn that this rate is less than 1%. When you are a public employee, you typically tend to have broader appeal rights because ERISA does not apply to your claim. Not only do you get an additional level of review performed by the California Department of Managed Health Care, but you could also potentially sue the insurance company directly for bad faith if they have broken the law in delaying or denying your claim.
Contact a Rancho Cucamonga Health Insurance Claims Denial Law Firm
If you are a public school employee, or any type of governmental worker in California who has had your claim wrongfully denied, speak to an Inland Empire health insurance claim denial attorney at Quincey Law. You can schedule a free initial consultation by filling out an online contact form or by calling us today at (866) 945-9175.
Nicholas Quincey is the founder of Quincey Law, and has over a decade of experience of handling insurance claims denials and personal injury matters for people throughout California. We have pursued insurance bad faith claims for people involving life insurance, health insurance, homeowners and disability insurance. We also work with clients and families who need assistance filing and pursuing a personal injury matter. Learn more here.