When the calendar flips and a new year dawns, so does a fresh set of surprises—not all of them good. Health insurance denials don’t wait for your schedule to catch up. At The Law Offices of Scott Glovsky, we’ve witnessed how these painful blindsides hit California patients when they’re already bracing for a fresh year: settling bills, planning treatments, and hoping for stability. Here’s how to get ahead of the next denial before it blindsides you.
1. Review Your Policy Before the New Year Kicks In
Every January marks a moment of renewal in your coverage: new deductibles, updated formularies, and sometimes shifting “medical necessity” standards. Get your Evidence of Coverage—the handbook your insurer sends—and read it closely. If anything feels vague or restrictive, flag it now. As we often tell our clients, know what’s on the page.
2. Secure Pre-Authorizations and Document Everything
Don’t wait. If you anticipate needing surgery, therapy, specialist treatment, or a pricey medication in the coming months, request prior authorization now. And here’s the crucial part: track it. Record dates, names, reference numbers, and what was approved—or denied. As our firm’s FAQ emphasizes, blurred records only help insurers, not patients.
3. Ensure Provider Network and Coding Accuracy
New year, new hiccups: one wrong provider code or an out-of-network specialist can trigger a denial. Confirm every doctor, facility, and billing code with your plan’s network—and demand clarity. These small details can separate paid claims from denied ones.
4. Know Your Appeal and External Review Rights
You have the right to appeal if your insurer denies your medicine, procedure, or treatment—even when it claims this is not medically necessary. California law protects you: internal appeals must be followed by an opportunity for an external review, often called an Independent Medical Review (IMR), at no cost. The state’s Department of Managed Health Care (DMHC) is your advocate, available to help resolve delayed or wrongly denied services.
5. Prepare to Escalate If Needed
Sometimes, the internal appeal hits a wall—or the insurer drags its feet. That’s when complaints and escalation matter. File a grievance, then request an IMR or mediated assistance via the CDI or DMHC. Don’t let it hide behind red tape—hold it accountable. Always keep copies of timelines, denial letters, and doctor notes. Documentation can win cases.
6. Let Us Stand by You
This work is emotional and exhausting—but you don’t have to do it alone. At The Law Offices of Scott Glovsky, we’ve spent over two and a half decades going toe-to-toe with insurers in California—and winning. We fight when bad faith collides with your health and peace of mind. We help make insurers give you the healthcare your doctor recommends. And—most importantly—we protect you from injustice, aggressively and personally.
Los Angeles Health Insurance Denial Attorney
When the new year brings fresh hope, set yourself up for protection, not surprises. If you're facing—or anticipating—an insurance denial, call us today for a free consultation at (626) 323-8351. We will stand with you, review your policy, navigate appeals, and fight for the care and justice you deserve.