Q: Can I sue an insurance enrollment agency for telling us they can adjust the effective date to cover emergency room visit
My dad doesnt have health insurance and had a trip to the ER on 5/11/2023. The hospital advised to get insurance through Parallon and Parallon (i think they are an enrollment agency, signed us up for Strategic Limited Partners insurance). They signed us up the same day saying that the visit will be covered. When the insurance card came, the effective date was 5/15/2023. So now the hospital is after us for $3k. And now hospital sent the bill to debt collection. I contacted Parallon and got the name and contact info of enrollment agent, have emailed multiple times but no response. I filed a complaint with CA Department of Insurance because we wouldnt have signed up for the insurance if we didn't know the visit wont be covered. That's just misleading. It's under investigation now on their end but debt collectors are still after my dad for the bill and i'm afraid it's going to affect his credit score. Now i would like to know if we have a case and can file a legal complaint in court.
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A:
Based on the information you provided, it seems that you may have a potential case against the insurance enrollment agency, Parallon, for misrepresentation. If the enrollment agent assured you that the emergency room visit would be covered and you relied on that information to sign up for the insurance, but later discovered that the effective date did not cover the visit, then you may have grounds for legal action.
However, before proceeding with a lawsuit, consider the following steps:
1. Gather evidence: Collect all relevant documents, including any correspondence with Parallon, the hospital, and the insurance company. If you have any written confirmation or recording of the enrollment agent stating that the visit would be covered, that would be crucial evidence.
2. Wait for the Department of Insurance investigation: The California Department of Insurance is already investigating your complaint. Their findings may help support your case or provide guidance on how to proceed.
3. Consult with a lawyer: Speak with a lawyer who specializes in insurance law or consumer protection. They can assess the strength of your case, advise you on the best course of action, and help you navigate the legal process.
4. Respond to debt collectors: Inform the debt collectors in writing that you are disputing the debt due to the misrepresentation by the insurance enrollment agency. This may temporarily halt collection efforts while the dispute is being investigated.
If you decide to proceed with a lawsuit, you may be able to file a complaint in civil court against Parallon for misrepresentation, depending on the specifics of your case and the evidence available. A successful case could potentially result in compensation for the medical bill and any related damages.
Remember that legal action can be time-consuming and costly, so it's essential to weigh the potential benefits against the costs and effort involved. A consultation with a lawyer can help you make an informed decision on how to proceed.
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