AllCare IPA

Health insurance is significantly more complex than it once was, for a variety of reasons. IPAs (Independent Physician Association, Independent Practice Association, or Independent Provider Association) are common in California. While there are certain benefits to getting your healthcare through an IPA, there can be challenges as well. 

IPAs contract with HMOs, PPOs, POS plans, and health insurance companies and are made up of a network of doctors, hospitals, imaging centers, and urgent care clinics. Physicians in the IPA can remain somewhat independent while reducing overhead costs and increasing their operational efficiency. Almost half of all California physicians were members of an IPA in 2022, allowing expanded negotiating power with health insurance companies. 

 If you are a member of AllCare IPA and have received a claim denial for a procedure or treatment your doctor believes will help you, it is easy to feel helpless and hopeless. After all, big insurance companies surely have an advantage over one person fighting for their rights to healthcare. While this is, unfortunately, true much of the time, there are exceptions. You do have options after receiving a claim denial, and those options can begin with speaking to an experienced insurance denial attorney from the Law Offices of Scott Glovsky. 

Scott has been fighting for his clients for more than two decades. When you hear someone say, “He wrote the book on that,” you take it to mean that the person in question is exceptionally knowledgeable, skilled, and experienced in the subject. Attorney Scott Glovsky is all those things, and he really did write the book on that. Scott’s book, Fighting Health Insurance Denials: A Primer for Lawyers, has become the training manual for law firms and lawyers. 

Overview of Insurance Provider AllCare IPA of California

AllCare Independent Physician Association (AllCare IPA) primarily serves patients in central and northern California. AllCare works closely with United Healthcare and other health plans as a delegated IPA responsible for coordination and authorization of care. 

AllCare health plans include an expansive network of physicians, currently including more than 1,000 private practice physicians in Merced, San Joaquin, and Stanislaus Counties. AllCare was founded in 1989 to prevent illness and promote a healthy lifestyle. As of May 2025, AllCare works with many health insurance companies including Aetna, Anthem Blue Cross, Blue Shield of California, Blue Shield of California Promise Health Plan, Cigna, Health Net, UnitedHealthcare, and others.

The AllCare physicians rely on the most advanced medical technology, and each physician in the IPA has satisfied a rigorous review of credentials. AllCare IPA strives to set standards for accessibility, convenience, and caring.  AllCare IPA offers a free comprehensive Health and Wellness Assessment to gather information about each individual’s health, focusing on preventative care and health screenings.  

Overview of AllCare IPA of California Claim Denials

In 2021-2022, allegations of the denial of a post-surgical follow-up appointment were alleged against AllCare IPA. A patient had surgery, which was authorized by United Healthcare with an out-of-network provider. The post-surgical follow-up appointment was then denied by AllCare IPA, who claimed it lacked authorization because the provider was out-of-network.  The follow-up visit was denied despite the initial surgery being authorized and the fact that post-operative care is part of a “global surgical authorization" covering this type of care. AllCare IPA eventually acknowledged the denial was in error after the patient filed a grievance. 

As a result of the denial, the patient experienced an unexpected financial burden, receiving a bill for $666 for the denied follow-up visit. The patient was forced to file a grievance and then wait for administrative resolution, which added emotional and financial strain. Situations like this can delay necessary follow-up care, resulting in more complications after surgical procedures. The California Department of Managed Health Care (DMHC) imposed a fine of $7,500 on AllCare IPA, forcing it to reprocess the claim and submit a Corrective Action Plan to prevent similar denials. 

What Are the Most Common Reasons Given by AllCare IPA of California for an Insurance Claim Denial?

Any insurance company can deny claims, although some tend to do so more often than others. AllCare IPA and other IPAs have a more complex situation; the relationship between the IPA and the insurance company means that either could be responsible for a claim denial. Some claim denials are for simple issues such as a miscoded procedure, insufficient information, or errors on the claim. These issues can be fixed, and the claim resubmitted. Some denials are the result of an out-of-network physician or hospital, while other treatments and procedures are specifically excluded in the policy. 

AllCare IPA denials could be related to coverage disputes. If a treatment or procedure happens to be especially costly, a denial can come in the form of it being deemed “not medically necessary,” “investigational,” or “experimental.” So, even if an IPA physician tells you that the treatment is medically necessary, the insurance company could deny it. The IPA can also deny a treatment or procedure, but it is less common and usually only for diagnostic tests or specialist referrals. Some procedures require pre-authorization, leading to confusion regarding whether the IPA or the insurance company is responsible for the approval. 

Sometimes, AllCare IPA could simply deny a claim wrongfully. This is known as a bad faith denial, and California policyholders can assert their rights against a bad faith denial.  As if all these reasons for denials are not enough, there can be deeper reasons why policyholders can receive a claim denial. AllCare IPA enters into contracts with health insurers. In essence, this changes an IPA into a small insurance company with the same financial incentive as a large insurance company to deny patient care.  

Capitation payments are fixed monthly payment amounts for each member in an IPA; the IPA receives these capitation payments regardless of whether a member uses his or her healthcare coverage. This means AllCare IPA could receive payment for many members without any outlay for services. Obviously, IPAs and health insurers want healthy members. But what about the members with medical issues requiring significant treatments, procedures, and hospitalizations? The capitation payments in these cases are not going to cover all the medical treatments. 

So, healthy patients result in the IPA getting a percentage of the unused capitation payments, while for patients who use more than the capitation payment, the IPA could be responsible for the overage. This clearly gives IPAs reason to deny healthcare claims for those members. Risk-sharing pools are similar to capitation payments. Insurers hold back a percentage of capitation payments at the start of each new year, placing that money in a risk-sharing pool. 

If the actual costs exceed the money held back, the IPA must pay a portion, while if the actual costs are less, the IPA receives a portion of the funds. Some physicians may have ownership interests in their IPA, which means they receive bonuses based on the IPA’s yearly profits. This is also an incentive to deny healthcare to members who have significant medical issues. 

What Should You Do if Your AllCare IPA of California Insurance Claim is Denied?

IPA healthcare claim denials tend to be more complex, requiring members to exhaust every administrative remedy provided under the Medi-Cal appeal process. For example, if your IPA refuses to approve a treatment or tells a member to go through step therapy, there is a significant benefit in speaking to an experienced health insurance claim denial attorney from the Law Offices of Scott Glovsky. 

Our firm helps members with Medi-Cal Managed Care Plans that also have a private insurance company involved such as an Anthem Blue Cross Medi-Cal Managed Care Plan, Promise Health Plan, Health Net Medi-Cal Managed Care Plan, Kaiser Medi-Cal Managed Care Plan, Health Net Medi-Cal Managed Care Plan, Molina Medi-Cal Managed Care Plan, and others. 

We understand every nuance of these claim denials and will work hard to turn a denial into an approval. Attorney Scott Glovsky routinely deals with big insurance companies and IPAs, which significantly increases your chances of a positive outcome following a denial. Attorney Scott Glovsky is here for you if you want an attorney who believes in justice for everyone and never hesitates to go up against a big insurance company. 

How the Law Offices of Scott Glovsky Can Help with an AllCare IPA of California Claim Denial

The Law Offices of Scott Glovsky is highly regarded for fighting insurance companies and healthcare organizations that delay or deny critical care. We are zealous patient advocates, ensuring patients understand their rights under federal laws and California’s Knox-Keen Act. When bad faith insurance practices are clear, we will file a lawsuit, negotiate a settlement, or push for a court trial when necessary. Under California’s Timely Access to Care laws, we hold IPAs and health plans accountable. When there are patterns of denial, we will push for policy changes and systemic accountability. 

If you have received an AllCare IPA denial, it is normal to feel angry and frustrated. It can feel as though you are all alone, with few options. You do have options, and those begin with speaking to a knowledgeable insurance denial attorney from the Law Offices of Scott Glovsky. Attorney Scott Glovsky received the California Lawyer Magazine’s California Lawyer of the Year Award and the Consumer Attorneys of California’s Street Fighter of the Year Award.

Scott has been designated as a Super Lawyer every year since 2006 and has been recognized by Best Lawyers every year since 2016. An AllCare IPA denial does not have to be the end of the matter. Attorney Scott Glovsky is a seasoned trial attorney who never hesitates to step into the courtroom and fight for justice against a large insurance company and/or IPA. If you want an attorney who will ensure you are treated with the respect and dignity you deserve while fighting on your behalf, contact the Law Offices of Scott Glovsky.