The Artvoice reported today that Blue Shield California twice refused to pay $2,700 emergency room claims by Rosalinda Miran-Ramirez, concluding that it was not a “reasonable” decision for her to go to the emergency room that morning when she awoke to a shirt saturated from blood with what turned out to be a breast tumor. Only after KPIX-TV reported the story did the insurance company pay the claim. Further, it reported that the National Women’s Law Center found that the laws of eight states permit insurance companies to deny health coverage to a battered spouse (as a “pre-existing condition”) since batterers tend to be recidivists.
No-Fault Providers Need Not Bill After a Denial
December 16, 2014
In State Farm v. Domotor 266 A.D.2d 219 (2nd Dept. 1999) the court held that after the no-fault carrier issues a denial of payment there is no need for the medical provider to send bills to the carrier. After the denial the provider can later litigate or arbitrate
