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Receiving a denial of health insurance coverage for your medical claim in Florida can be very stressful. Most medical treatments are very expensive and the amount of bills can add up very quickly. These situations can often to lead to aggravated health issues and unnecessary financial troubles. Some health insurance providers may deny your medical claims, even if they were necessary. If you have been denied health insurance coverage for an illegal reason, or have a legitimate health insurance claim, but your provider denied your claim in bad faith, it is important to hire an experienced insurance lawyer in Tampa.
Contact the Germain Law Group at (813) 835-8888 for a consultation about your health insurance claims in Tampa, Florida. Attorney Michael B. Germain is knowledgeable in all areas of Florida’s insurance laws and is experienced in all aspects of health insurance. Call the Germain Law Group today about your health insurance claim or claim denials throughout the areas in Hillsborough County, Pinellas County, Brevard County and Manatee County, Florida.
Tampa Health Insurance Information Center
Health insurance is defined in Fla. Stat. § 624.603 as insurance covering humans against bodily injury, disablement or death by accident or accidental means. Health insurance also covers the expenses arising from such injury or sickness. However, health insurance does not typically include workers’ compensation coverage.
Many people are usually eligible for health insurance in Florida, even if they have a preexisting medical condition. Although many insurance policies will deny coverage altogether or place an exclusion in the policy denying coverage for preexisting conditions for individuals with conditions such as diabetes, high cholesterol, obesity, heart disease and cancer, some will increase the insurance rates. Under Florida law, if someone develops HIV or AIDS, their health insurance provider is not permitted to drop their coverage or refuse to renew their coverage (Fla. Stat. § 627.6265).
Health insurance policies typically do not cover any losses resulting from the insured being intoxicated or under the influence of drugs, committing or attempting to commit a felony, or engaging in an illegal occupation.
When an individual desires to file a claim with their health insurance policy for any loss or treatment, they are usually required to submit a written proof of loss the insurer within 90 days after the loss, or within a reasonable period not to exceed one year if the insured was unable to provide the proof of loss within the typical time period (Fla. Stat. § 627.612).
Health insurance providers are required by law to make a decision on a claim within 120 days after receiving the claim under Fla. Stat. § 627.613. If the claim is not paid timely, the insurance company is required to pay interest on the amount due.
After a claim has been filed, insurers are permitted under Florida law to require the insured have a physical examination as often as reasonably necessary while the claim is pending under Fla. Stat. § 627.615.
Insurance companies will often find any reason not to pay a health insurance claim. These can usually include the treatment was experimental, not medically necessary or cosmetic. Health insurance companies may also deny claims because the medical condition was preexisting, a misstatement was made in the application for the insurance policy and the insured did not make payments on the insurance premiums.
However, health insurers are not legally permitted to deny a medical claim in Florida within two years after issuing the policy for misstatements in the application and preexisting medical condition according to Fla. Stat. § 627.607.
If anyone has had their claim denied as not medically necessary must be given an opportunity to appeal to the insurer’s physician who was responsible for the not medically necessary review under Fla. Stat. § 627.6141. The physician’s response to the appeal must be within a reasonable period of time, not exceeding 15 business days.
According to Florida law (Fla. Stat. § 627.613), after a health insurance claim has been denied or contested, the insurance company must provide you with the contested portion of the claim and the specific reason for the denial in writing within 45 days after receiving notice of the medical claim. If any missing information that would make the claim valid is required, the insurance company must pay or deny the claim within 60 days after receiving the missing information.
Florida Department of Health – The Florida Department of Health regulates all aspects of health care in state of Florida and seeks to protect and promote the health of all residents and visitors in the state.
Health Flex Plan – The Agency for Health Care Administration provides the Health Flex Plan for low-income uninsured state residents in certain counties in Florida, including Hillsborough County.
SHINE – Serving Health Insurance Needs of Elders – This state health insurance assistance program provides educational materials and health insurance counseling to elder Floridians, their caregivers and family members.
Florida CHAIN – This Florida organization, Community Health Action Information Network, is dedicated to improving the health of the citizens of Florida by promoting access to affordable and quality health care for all citizens.
Florida KidCare – This organization provides affordable and low cost health insurance for uninsured children throughout the state.
Florida Health Finder – This website, provided by Florida’s government, gives Floridians access to health information throughout the state, including pricing of various health plans, medical brochures, resources and access to locating a healthcare provider or facility.
Florida Statutes Online – This website provides links to Title XXXVII of the Florida Statutes, entitled “Insurance,” which contains the state’s rules insurance companies must follow, definitions of certain insurance terms, and other provisions regarding rates, statutes of limitations and insurance contracts.
Germain Law Group, P.A. | Health Insurance Attorney in Tampa
Contact the Germain Law Group today for a consultation about your health insurance claim in Hillsborough County, Pinellas County, Brevard County and Manatee County. Michael B. Germain is a knowledgeable Tampa insurance lawyer who will listen to the facts of your situation and help you determine the best recourse in pursuing your claim for your denied health insurance claim. Contact the Germain Law Group at (813) 835-8888 for a consultation about your insurance claim throughout Central Florida, including Tampa, St. Petersburg, Clearwater, Titusville, Palm Bay, Melbourne, Bradenton and Palmetto.