Medical Billing Insurance Disputes

Medical billing insurance disputes typically arise when your insurance provider denies payment of any health services or treatments you have received, and as a result are stuck with very costly bills. As the amount of the bills continue to increase and your insurance provider continues to dispute or deny payment of the medical claims, you could end up in financial ruins and even be forced to file for bankruptcy.

If your medical bills have been wrongfully denied or disputed by your insurance company or your provider acts in bad faith when denying your medical claim, it is important to hire a knowledgeable Tampa health insurance attorney.

Tampa Medical Billing Insurance Disputes Lawyer

Contact the Germain Law Group at (813) 835-8888 for a consultation about your health insurance billing dispute in Tampa, Florida. Attorney Michael B. Germain is knowledgeable in all areas of Florida’s insurance laws and is experienced in all aspects of medical billing insurance disputes. Call the Germain Law Group today about your health insurance claim denial throughout the areas in Hillsborough County, Pinellas County, Brevard County and Manatee County, Florida.

Back to top

Medical or Health Insurance Coverage in Florida

Florida law defines health insurance Fla. Stat. § 624.603 as insurance for people against bodily injury, disablement or death by accident or accidental means. Health insurance also covers any expenses arising from injury or sickness.

Your insurance company may claim your condition was preexisting and not covered by the policy, so your claim was denied as a result. However, most people in Florida are eligible for health insurance in Florida, even if they have a preexisting medical condition. Although some insurance carriers will place an exclusion in the policy denying coverage for preexisting conditions such as diabetes, high cholesterol, obesity, heart disease and cancer, some will instead increase the insurance rates. If your claim has been denied, it is important to look at your policy and determine if your preexisting condition was covered or excluded.

Health insurance policies will usually not cover injury or illness claims for treatment that resulted from the policyholder committing or attempting to commit a felony, when they were under the influence of alcohol or drugs, or from engaging in an illegal occupation, such as dealing drugs. If your medical bill was denied payment by your insurance provider for any of the preceding reasons, it is important to look at your policy and determine if any of these reasons are excluded from your coverage.

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 your insurance company does not make a timely decision on your claim, they are likely acting in bad faith and may be required to pay interest on the amount due to cover your claim.

Back to top

Medical Billing Insurance Denials and Disputes in Tampa

Insurance companies will deny your claim for a variety of reasons. Your provider may claim the denial was a result of any of the following reasons:

  • Some exclusion in your policy,
  • The treatment was experimental or cosmetic,
  • The premium on your policy was not timely paid, so there was no coverage,
  • There was a misstatement in your application for health insurance, and/or
  • The treatment was fraudulently received by someone not covered in the policy.

If your insurer does not pay your claim because they allege the treatment was not medically necessary, you must be given an opportunity to appeal to the insurer’s physician who determined the treatment was not medically necessary according to Fla. Stat. § 627.6141. The physician’s response to your appeal must be given to you within a reasonable period of time that does not exceed 15 business days.

When your insurance provider refuses to pay your medical bills, they must provide you with the contested portion of your medical bill claim and the specific reasons for denial of your medical bill payment in writing within 45 days after receiving notice of your claim, according to Fla. Stat. § 627.613. If they fail to follow these procedures, they may be acting in bad faith.

Back to top

What to Do After Your Medical Bill Has Been Denied in Tampa

If your medical bill has been disputed, payment has been delayed or payment has been denied altogether, you should examine your policy and find the specific reason your claim was denied. Determine if there are applicable exclusions in your policy or if your coverage does actually cover your medical treatment.

Remember to keep any documentation, record of conversations and any other evidence that can be used to defend your medical billing dispute.

Even if your medical bill was not completely disputed and partially paid, you do not have to settle for partial payment. You are entitled to receive what your health insurance contract covers, and any breaches of the contract may be in bad faith.

Medical billing disputes can be frustrating, time-consuming and costly, so it is important to hire an experienced Tampa insurance lawyer to represent your interests and proceed with any necessary legal action on your behalf.

Back to top

Germain Law Group, P.A. | Medical Billing Dispute Attorney in Tampa

Contact the Germain Law Group today for a consultation about your medical billing claim in Hillsborough County, Pinellas County, Brevard County and Manatee County. Michael B. Germain is a knowledgeable health insurance lawyer in Tampa who will listen to the facts of your situation and help you determine the best recourse in pursuing your medical insurance claim. Contact the Germain Law Group at (813) 835-8888 for a consultation about your health insurance issues throughout Central Florida, including Tampa, St. Petersburg, Clearwater, Titusville, Palm Bay, Melbourne, Bradenton and Palmetto.