How did the world ever function without insurance?  We have insurance for our cars, our homes, our health, our careers, our animals, our body parts, etc.  Does this passion for insurance blind consumers from researching valid products in the industry?  Health insurance, as of late, is one type that has been forced upon Americans by federal guidelines.  If a provider (or a fraudulent provider) of insurance takes money for premiums while offering a subpar product, they must be reported and legal action should probably be initiated.  Contact an experienced attorney in Hollywood Florida to navigate actions where one parent believed they were paying for children’s insurance that did not cover necessary medical care.

Fraud.

A Hollywood-based company called Simple Health Plans lured and collected more than $100 million in premiums selling sham health insurance “for smart people” through a network of deceptive websites, including one called trumpcarequotes.com, was ordered by a federal judge to temporarily shut down following consumer complaints to the Federal Trade Commission.

Denials.

Insurance companies deny claims for a variety of reasons, and sometimes they might be legitimate ones that can be re-submitted and returned with a favorable decision to pay the claim.  Legitimate reasons for a denial might include:

  • There was a mistake on the application.
  • Lack of coverage:
  • Your claim doesn’t cover the treatments you are seeking.
  • The claim was not filed correctly.
  • Policy modifications post claim filed.
  • If you misrepresent your true medical expenses and procedures.

Report.

When insurance fraud is the reason for the denial, it will be necessary to hire an attorney to file a civil suit against them for accepting payment for sham insurance.  Denial of legitimate claims on a paid-up policy could be an incident of consumer fraud which is actionable in court as is the case for anyone who bought the limited policies from Dr. Stephen Dorman’s sham insurance company.  If the designated parent was paying for childcare, and the other parent incurred expenses because of the fraudulent insurance plan, action will need to be taken for both parents based on the best interests of the children of a marriage.

Insurance policies are a contract between the insured party and the provider, so when a dispute about questions of coverage, or denial of legitimate claims comes up, the state contract laws will be the basis of argument for your case. Contract law governs most of insurance dispute proceedings. An insurance company should offer fair compensation in a timely manner and may not “low-ball” offers of settlement or delay payment.

Collect all documents regarding communication with the sham insurance company, and relevant claim submissions and share that information with an attorney, and the consumer protection offices in Florida.  Contact the Florida Department of Insurance Consumer Services Division at: Statewide Toll-Free: 1-877-MY-FL-CFO (1-877-693-5236); Out of State Callers: (850) 413-3089; TDD Line: 1-800-640-0886; Email Address: [email protected] (Keep contact person names and numbers, and a copy of filed complaint.)

Hire an attorney.

If you find yourself in an insurance dispute arising out of denied claims from a sham health insurance provider on a policy that covered your children, contact the Law Offices of Jodie Bassichis for assistance in resolving any conflict with the other parent, and for advice for action against the fraudulent company.

The Law Office of Jodie Bassichis, P.A.,
The Presidential
4000 Hollywood Blvd.
South Tower 555
Hollywood, FL 33021

 

Sources.

http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0600-0699/0627/Sections/0627.7011.html

https://www.ftc.gov/news-events/press-releases/2018/11/ftc-halts-purveyors-sham-health-insurance-plans

https://www.floir.com/

https://www.miamiherald.com/news/health-care/article221144235.html