Blue Shield of California Claims Denial Lawyer

Not only may you be shocked and dismayed when Blue Shield of California has denied your insurance claim, but your very health can be at risk. California law has strict protections for health insurance customers like you, and you can take legal action to both force Blue Shield to pay for your claim and potentially even to force them to pay you further damages.

At Quincey Law, we firmly believe in our mission of fighting for the rights of individuals who have been victimized by wrongful insurance company practices. Attorney Nicholas Quincey is an experienced litigator who uses his courtroom know-how to hold insurance companies accountable for their wrongful actions. Contact us to learn how we can help. 

Quincey Law has office locations in Orange County & San Bernardino County and handles Blue Shield of California claim denials throughout the entire state of California. Contact Quincey Law at (866) 945-9175 or fill out a contact form to learn how we can vigorously protect your legal rights to have your Blue Shield of California health insurance claim covered.

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“Nick fights hard for his clients. Guided by a strong moral compass, he provides fair and honest insight as to what is in your best interest. He is incredibly diligent, and a straight shooter. You feel like he is always in the trenches with you, and guiding you through tough times. I am so grateful to have worked with him on matters over the last few years. I cannot recommend him highly enough.”
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Blue Shield Has a High Rate of Claim Denials

Even as the Affordable Care Act was passed and signed into law, Blue Shield of California denied over 20% of claims. While the company used the ACA as justification for hiking premiums as much as nearly 60%, it continues to deny claims at an alarming rate, and the situation is not getting any better. Blue Shield of California has an extremely high rate of complaints with the State. 

In one recent dispute, Blue Shield has threatened to terminate Providence Hospitals from its network. In turn, Providence has countered by claiming that Blue Shield is denying patient treatments at an “alarming rate.” Providence has noted that Blue Shield denials have gone up by 11% thus far in 2024. The hospital claims that Blue Shield has denied roughly $250 million in claims over the preceding four-year period. 

In fact, Blue Shield has been named in a recent class action lawsuit that alleges the company wrongfully used artificial intelligence in processing claims. The lawsuit alleges that Blue Shield used a program called the Claims Data Activator to instantly deny claims for lack of medical necessity, notwithstanding provider documentation to the contrary that the company had on file. 

In multiple other cases, Blue Shield has been successfully sued for denying mental health treatment claims for lack of medical necessity. In 2018, the company settled a class action lawsuit for $7 million because it instituted improper criteria for determining whether certain types of mental health treatment were medically necessary, resulting in their denial. 

Denied claims may be catastrophic when they happen to you or a loved one. These denied claims represent treatment that you may critically need. You could end up with a large bill because you simply could not do without the treatment. In other cases, you may need to forgo life-saving care because you simply cannot afford it. California law may be on your side, but you need a tough health insurance claims denial attorney to stand up to the insurance company. 

Why Blue Shield Denies Health Insurance Claims

Blue Shield often gives the following justifications for denying you the care that they promised:

• The care is not medically necessary
• The treatment is not covered by the terms of your policy
• The treatment is too expensive, and there is a more affordable option available
• The paperwork is incomplete

You do not simply have to take Blue Shield’s reason for claim denial at face value. You can hire a health insurance claim denial attorney to file a lawsuit and fight for you to get coverage (and potentially damages for the wrongful actions).

You May Be Able To File a Bad Faith Lawsuit Against Blue Shield

Under California law, insurance companies do not have carte blanche to do whatever they want and deny treatment at every turn. California state law is the Achilles heel for health insurance providers like Blue Shield because it allows you to file a lawsuit against them when they have wrongfully denied your claim, or they have unreasonably delayed payment. 

Not every claim denial is automatically considered to be bad faith. The insurance company must act unreasonably in denying your claim. Here, they may have refused to provide coverage that is allowed under the terms of your policy. You must show insurance company unreasonableness to win a bad faith lawsuit. 

Although you must overcome a relatively high bar to win a bad faith lawsuit, you may be entitled to a substantial amount of damages when you win your case. First, you may be able to force the insurance company to provide the coverage that you need. Second, the insurance company could be made to face drastic consequences.  

Damages in a California Insurance Bad Faith Lawsuit

You may be entitled to the following damages if your bad faith lawsuit against Blue Shield California is successful:

• Injuries that you suffered when your condition grew worse because of the failure to cover your claim
• Emotional distress when you suffer mental health conditions from having to deal with the insurance company’s tactics
• Attorney’s fees
• Punitive damages when the jury wants to make an example out of the insurance company

Punitive damages are how you can really hit the insurance company where it hurts. In some cases, insurance companies have been ordered to pay millions of dollars in punitive damages. 

You need a tough lawyer who is able to stand up to large companies like Blue Shield California. They have lawyers of their own who are paid a great deal of money to protect the insurance company. You must have an attorney who knows how to take the fight to a health insurance provider when they have wrongfully denied your claim.

Contact a Blue Shield of California Bad Faith Insurance Lawyer

Quincey Law handles claims against large insurance companies like Blue Shield throughout the state of California. Call (866) 945-9175 or fill out our confidential contact form to speak to someone at our office. Together, we can seek justice.