Health Insurance Lawyer in Florida: Your Trusted Legal Partner
When you suffer an injury or illness, the last thing you want is to fight with your insurance company over how much money they owe you. Unfortunately, these kinds of disputes are not uncommon for individuals who rely on their health insurance plans for medical care and treatment.
If you’re worried about covering denied claims or rescissions or have been accused of material misrepresentation, don’t try to handle your case by yourself. Speak with a Florida health insurance lawyer at Dyson Law, PLLC. We have extensive experience helping patients receive their benefits.
What Happens When an Insurance Claim Is Denied?
Private health insurance should cover many of the costs associated with hospital stays and medical visits. But that doesn’t mean health insurance companies always pay what they owe their policyholders. Unfortunately, you may have trouble getting the coverage you’re due.
In fact, they often fail to be ethical in their dealings with policyholders because they’re for-profit businesses. This is especially true for services provided by doctors who treat patients covered by a given insurer’s policies at out-of-network facilities or under certain types of contracts. People with managed care plans may have specific trouble with this type of claim.
However, health insurance companies have a duty to act in good faith when handling claims. They also have a duty not to mislead policyholders about their rights under their policies.
A health insurance lawyer in Florida can confirm whether your insurer is obeying the law and assist you with covering denied claims. That way, you don’t have to worry about paying your own medical bills when you’re sick or otherwise unable to work.
Many Health Insurance Policies are Purposefully Vague
Health insurance policies frequently contain ambiguous terms that make it challenging for individuals to determine if a treatment or procedure is covered. This ambiguity allows insurance companies to wrongfully deny claims. Consequently, patients often discover that their insurance provider will not fulfill its obligations under the policy, resulting in the denial of necessary medical or psychological treatments recommended by their healthcare professionals.
How long does an insurance company have to deny a claim in Florida?
In Florida, an insurance company has 120 days to either pay or deny a claim after receiving it. If the insurance company does not make a decision within this timeframe, they are required to pay interest on the amount due.
What is the 90 day rule in Florida Insurance?
The 90-day rule in Florida insurance requires that you submit written proof of loss or treatment to your insurance company within 90 days of the loss. If you are unable to meet this deadline, you have up to one year to provide the proof, as long as you have a valid reason for the delay.
What If My Health Insurance Policy Was Canceled?
The term rescission is used by insurance companies when they decide to cancel your policy after learning you lied or misrepresented information on your application. A rescission letter typically contains information about the reason for termination and gives you a limited time to respond with any evidence that could help your case.
If you receive a rescission letter from your insurance company, you must respond within thirty days to dispute the cancellation. You can send this letter by certified mail so it has proof of delivery. Your lawyer can help you include all relevant documents in your response, such as medical records and prescription receipts if applicable.
If your insurance provider does not agree with your response, they may file an appeal with the Florida Department of Financial Services (DFS) Division of Insurance Administrative Hearing Office (AHO).
Once this happens, you must also file an appeal with AHO within thirty days. Dealing with a large, national insurance company during the appeals process can be intimidating. But your Florida health insurance attorney will be by your side every step of the way when going through this stressful process.
When a Health Insurer Accuses You of Lying
If you bought a health insurance plan in the past few years, it’s likely that you were asked a series of questions about your medical history. You may have thought that these answers would never be used against you. However, if you made a material misrepresentation on your application for health insurance, then you could find yourself in legal trouble.
A material misrepresentation is an untruthful statement made during the application process for insurance. It can be as simple as saying that you don’t smoke when you do. This could impact how much money the company pays out in claims for you or how much you pay for premiums.
A health insurance lawyer in Florida can help you collect the evidence and information you need to help prove your innocence and get your claim paid.
File a Complaint with a Health Insurance Lawyer in Florida
The importance of having an attorney cannot be overstated if you are having problems covering denied claims, dealing with rescissions, or facing accusations of material misrepresentation. Many people fail to realize that they have rights when issues like these arise with their insurance policy.
The attorneys at Dyson Law, PLLC are there to ensure these rights are upheld for all our clients. Start with a free consultation, so you’ll know what to expect from your lawyer. Call 561-498-9979 or complete our online form to discuss your case with a Florida health insurance lawyer who’s unafraid to take on the big insurers on your behalf.
