Patients Should Seek Legal Advice When Their Florida Health Insurance Claim Is Denied

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

The health care system and the health insurance market are changing rapidly with the implementation of the Affordable Care Act (ACA) (“Obamacare”), and the uncertainty regarding the legal status of tax credits for individuals who purchase insurance through the federal exchange.  Since Obamacare continues to be the law of the land at the time of writing this blog, the perspective of this blog will presume that the health law remains intact following the Supreme Court decision in the pending case before the U.S. Supreme Court.  Although many people are under the impression that Obamacare means that health insurance claims will be universally covered because the law eliminated the pre-existing conditions restriction, health insurance claim denials are not going away.

When you are sent a denial letter regarding your Florida medical insurance claim, the specter of incurring enormous personal expense can be extremely concerning.  Medical costs have skyrocketed, so a hospital stay along with diagnostic procedures and treatment can be staggering in cost.  If your health insurer denies your claim, the stress associated with financial hardships can exacerbate your health issues.  When your legitimate health insurance claim is denied based on bad faith practices, it is critical that you speak with an experienced insurance lawyer in Miami.

Under Fla. Stat. Section 624.603, “health insurance” is defined as insurance that covers people against disablement, bodily injury or death by accident or accidental means.  Health insurance also provides coverage for costs incurred from sickness or injury provided the injury is not incurred in the course and scope of employment.  While Obamacare narrowed the scope of reasons for which an insurer could deny coverage by eliminating the pre-existing condition basis for denying coverage, Florida already had special protections from cancellation or refusal to deny coverage if a policyholder developed HIV or AIDS.

Insurance companies often rely on a plethora of reasons to deny legitimate claims.  The insurer might base such a denial on an alleged inaccurate statement or non-disclosure on the application.  Similarly, the insurer may contend that the medical procedure is not medically necessary or cosmetic or that the procedure is excluded by language in the policy.  Disputes also can arise because of alleged non-payment of policy premiums.  When these types of disputes arise or a health care provider cancels or refuses to renew a policy, policyholders should speak to an experienced Miami health insurance attorney.

My law firm represents policyholders in health insurance claims disputes in Miami and throughout Florida.  The Law Firm of J.P. Gonzalez-Sirgo, P.A. offers free consultations and case evaluations with an experienced Miami health insurance claims attorney.  No Recovery, No Lawyer Fees.  Call 305-461-1095 or Toll Free 1-866-71-CLAIM.

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